Although corneal crosslinking (CXL) is routinely performed under local anesthesia in adults and cooperative pediatric patients, younger children and those with developmental delay disorders may require general anesthesia to undergo the procedure. Researchers from San Francisco recently conducted a retrospective case study that demonstrated favorable outcomes using general anesthesia to perform CXL in patients who have developmental delay or display lack of cooperation.
This is especially relevant given the higher incidence of keratoconus (KCN) among patients with Down syndrome. Also, eye rubbing—another risk factor for KCN—is common in patients with developmental delays.
The study reviewed 14 eyes of nine pediatric KCN patients, all of which had CXL under general anesthesia. All were habitual eye rubbers at baseline, and six patients were developmentally delayed. Compared with unaffected subjects, the developmentally delayed patients were diagnosed and treated at older ages, experienced longer delays from diagnosis to treatment, had lower best-corrected visual acuity (BCVA), higher steep keratometry values, a higher incidence of corneal scarring and monocular vision loss at baseline. However, none of the results were statistically significant.
The researchers noted that no anesthesia or surgical complications occurred. BCVA and keratometry values were stable at six months post-op, with no clinically or statistically significant change observed for either measure. The study also found that that eight patients decreased or stopped eye rubbing post-treatment.
The researchers concluded that these findings raise awareness regarding a vulnerable population who may beneﬁt from improved clinical recognition and access to treatment. Early treatment is crucial in pediatric KCN, particularly for patients with developmental delay, for whom later-stage surgical options may not be feasible. They recommended that practitioners pay greater attention to the unique social and care coordination needs of their patients with developmental delay to preserve their vision and quality of life.
|Ahmad TR, Pasricha ND, Rose-Nussbaumer J, et al. Corneal collagen crosslinking under general anesthesia for pediatric patients with keratoconus and developmental delay. Cornea. November 7, 2019. [Epub ahead of print].|