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International Ophthalmology
Published in: International Ophthalmology 3/2018

Open Access 01-06-2018 | Original Paper

Performing corneal crosslinking under local anaesthesia in patients with Down syndrome

Authors: Nienke Soeters, Esmée Bennen, Robert P. L. Wisse

Published in: International Ophthalmology | Issue 3/2018

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Abstract

Purpose

To report on the ability to perform corneal crosslinking (CXL) under local anaesthesia for the treatment of keratoconus in patients with Down syndrome.

Methods

Nine eyes of seven patients with both keratoconus and Down syndrome were scheduled for an epithelium-off CXL procedure under local anaesthesia. Exclusion criteria were a corneal thickness under 400 µm and the presence of corneal scars. A standardized clinical decision tool was used to estimate patient cooperation and the likelihood for a successful procedure under local rather than general anaesthesia.

Results

In seven eyes, the CXL was completed successfully. The treatment was aborted in two eyes due to insufficient corneal thickness (<400 µm) prior to ultraviolet-A irradiation, even after employing hypoosmolar riboflavin. No adverse events occurred post-operatively, except for one case of delayed epithelial healing (23 days).

Conclusions

With a proper patient selection, CXL under local anaesthesia can be achieved in patients with Down syndrome.
Literature
1.
Hofmann H (1956) Acute keratoconus with mongoloid idiocy. Klin Monbl Augenheilkd Augenarztl Fortbild 129:756–762PubMed
2.
Shapiro MB, France TD (1985) The ocular features of Down’s syndrome. Am J Ophthalmol 99:659–663CrossRefPubMed
3.
Hestnes A, Sand T, Fostad K (1991) Ocular findings in Down’s syndrome. J Ment Defic Res 35:194–203PubMed
4.
Woodward MA, Blachley TS, Stein JD (2016) The association between sociodemographic factors, common systemic diseases, and keratoconus: an analysis of a nationwide heath care claims database. Ophthalmology 123(457–65):e2
5.
Van Splunder J, Stilma JS, Bernsen RMD, Evenhuis HM (2004) Prevalence of ocular diagnoses found on screening 1539 adults with intellectual disabilities. Ophthalmology 111:1457–1463CrossRefPubMed
6.
Krachmer JH, Feder RS, Belin MW (1984) Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol 28:293–321CrossRefPubMed
7.
Vincent AL, Weiser BA, Cupryn M et al (2005) Computerized corneal topography in a paediatric population with Down syndrome. Clin Exp Ophthalmol 33:47–52CrossRefPubMed
8.
Doyle SJ, Bullock J, Gray C et al (1998) Emmetropisation, axial length, and corneal topography in teenagers with Down’s syndrome. Br J Ophthalmol 82:793–796CrossRefPubMedPubMedCentral
9.
Aslan L, Aslankurt M, Aksoy A, Gümüşalan Y (2014) Differences of the anterior segment parameters in children with down syndrome. Ophthalmic Genet 35:74–78CrossRefPubMed
10.
Rabinowitz YS, Zu L, Yang H et al (1999) Keratoconus: non-parametric linkage analysis suggests a gene locus near the centromere of chromosome 21. Investig Ophthalmol Vis Sci 40:S564
11.
Wisse RPL, Kuiper JJW, Gans R et al (2015) Cytokine expression in keratoconus and its corneal microenvironment: a systematic review. Ocul Surf 13:272–283CrossRefPubMed
12.
Frantz JM, Insler MS, Hagenah M et al (1990) Penetrating keratoplasty for keratoconus in Down’s syndrome. Am J Ophthalmol 109:143–147CrossRefPubMed
13.
Bodenmueller M, Frueh BE, Keratoplastik P (2003) Perforierende Keratoplastik bei Trisomie 21. Klin Monbl Augenheilkd 220:99–102CrossRefPubMed
14.
Wittig-Silva C, Chan E, Islam FMA et al (2014) A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. Ophthalmology 121:812–821CrossRefPubMed
15.
Wollensak G, Spoerl E, Seiler T (2003) Riboflavin/ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 135:620–627CrossRefPubMed
16.
Seiler TG, Schmidinger G, Fischinger I et al (2013) Complications of corneal cross-linking. Ophthalmologe 110:639–644CrossRefPubMed
17.
Borland LM, Colligan J, Brandom BW (2004) Frequency of anesthesia-related complications in children with Down syndrome under general anesthesia for noncardiac procedures. Paediatr Anaesth 14:733–738CrossRefPubMed
18.
Santamaria LB, Di Paola C, Mafrica F, Fodale V (2007) Preanesthetic evaluation and assessment of children with Down’s syndrome. Sci World J 7:242–251CrossRef
19.
Lewanda AF, Matisoff A, Revenis M et al (2016) Preoperative evaluation and comprehensive risk assessment for children with Down syndrome. Paediatr Anaesth 26:356–362CrossRefPubMed
20.
Spoerl E, Mrochen M, Sliney D et al (2007) Safety of UVA-riboflavin cross-linking of the cornea. Cornea 26:385–389CrossRefPubMed
21.
Faschinger C, Kleinert R, Wedrich A (2010) Corneal melting in both eyes after simultaneous corneal cross-linking in a patient with keratoconus and Down syndrome. Ophthalmologe 107:951–952CrossRefPubMed
22.
Koppen C, Leysen I, Tassignon M-J (2010) Riboflavin/UVA cross-linking for keratoconus in Down syndrome. J Refract Surg 26:623–624CrossRefPubMed
23.
Sabti S, Tappeiner C, Frueh BE (2015) Corneal cross-linking in a 4-year-old child with keratoconus and Down syndrome. Cornea 34:1157–1160CrossRefPubMed
24.
Hafezi F (2015) Light for sight 21 raises awareness, promotes detection and treatment of keratoconus in children with Down syndrome. Ocular Surgery News. Accessed 10 Aug 2015
25.
Soeters N, Wisse RP, Godefrooij DA et al (2015) Transepithelial versus epithelium-off corneal cross-linking for the treatment of progressive keratoconus: a randomized controlled trial. Am J Ophthalmol 159:821–828CrossRefPubMed
26.
Ozcan AA, Ersoz TR (2007) Severe acute corneal hydrops in a patient with Down syndrome and persistent eye rubbing. Ann Ophthalmol (Skokie) 39:158–160CrossRef
Metadata
Title
Performing corneal crosslinking under local anaesthesia in patients with Down syndrome
Authors
Nienke Soeters
Esmée Bennen
Robert P. L. Wisse
Publication date
01-06-2018
Publisher
Springer Netherlands
Published in
International Ophthalmology / Issue 3/2018
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-017-0535-1

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