Cross-linking in Children

Keratoconus is a disease of young people and is most common and most aggressive in children and adolescents (8 to 19 years). It is therefore very important to carry out regular follow-up checks here. Above all, the children of adult patients with keratoconus should also be examined.

Our group has one of the longest international experiences in the treatment of children and adolescents. This particular age group requires special care and attention because the risk of postoperative complications such as infection can be greatly increased.

Immediate treatment

Unlike adults, children and adolescents are immediately cross-linked as soon as the keratoconus is clearly diagnosed. So there are no historical controls planned to prove the deterioration.

This is because one of the first major studies of CXL in children (in 2012) clearly showed that keratoconus worsened in 88% of all children and adolescents aged 8 to 19. This study comes from our research group. These results made it clear that if the disease worsens in 9 out of 10 children and adolescents, there should be no hesitation in treating the condition immediately.

Results

The results of cross-linking in children and adolescents are as excellent as they are in adults: the disease can be stopped with a high rate of success. In adults, we usually have to wait six months to see if the CXL treatment has succeeded, but in children and adolescents we can often determine success after just three months.

The effect is greater in children

Extreme improvement

We often see children react more clearly and more strongly than adults. The topography below shows a remarkable result early after crosslinking the right eye: the cornea not only stabilized, but also underwent a flattening of more than 5 diopters after 7 months.

7 months after CXL

Before CXL

Improvement

Faster deterioration

A 15-year-old boy with a decrease in visual acuity in his right eye that started 3 months before the first consultation. The patient and his parents were asked to come to a follow-up after 4 weeks. Unfortunately, they did not reappear until 3 months later. The right picture shows the massive deterioration after just 3 months.

September 2009

May 2009

Deterioration

The procedure

Cross-linking in children and adolescents is exactly the same as for adults. Because the treatment is painless, we can also treat children over the age of 9 under local anaesthesia. For children under the age of 9 years, if necessary, we will perform the treatment under general anaesthesia: our anaesthetists will discuss this with you separately.

Epi-on or Epi-off?

This is a difficult decision in children. CXL requires the second layer of the cornea, the stroma, to be saturated with riboflavin. Unfortunately, the first layer of the cornea, the epithelium, stops riboflavin from penetrating into the stroma.

Epi-off CXL

Therefore, CXL usually involves removing the epithelium in the center of the cornea so that riboflavin can penetrate into the stroma directly. This technique is called “epi-off CXL”, because the epi(thelium) is taken off. Epi-off CXL exists since 2002.

A major disadvantage of epi-off CXL is that removal of the epithelium can cause substantial pain: children tend to rub their eyes immediately after surgery, which increases the risk for (dangerous) corneal infection.

Epi-on CXL

In epi-on CXL, the epithelium is not removed. Special eye drops (penetration enhancers) are used to get the riboflavin through the epithelium into the stroma. The infection risk is virtually null and there is no pain, just a slight discomfort, but the effectiveness might be slightly lower than epi-off CXL. Successful epi-on CXL exists since 2019, .

Which method for your child?

– Epi-off CXL has 20 years of data showing effectiveness and it has the greatest chance of stopping keratoconus progression, but it is a little riskier.

– Epi-on CXL is approaching the effectiveness of epi-off CXL, makes the immediate period after surgery more comfortable for the child and decreases the risk for infection.

Therefore, we will decide individually by assessing each child. If there are doubts that a child will cope well with the post-surgical eye drop and bandage contact lens wearing regimen, then we may propose using epi-on CXL.

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Augeninstitut ELZA
4.8
Based on 107 reviews
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Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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