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Outcomes of corneal collagen cross-linking (CXL) in children with keratoconus (KC)

Poster Details


Co Author(s): S. Hamada                    

Abstract Details


The aim was to prove the safety and efficacy of corneal collagen cross-linking (CXL) in progressive pediatric keratoconus (KC). To present a novel technique where corneal epithelium is physically disrupted but not removed.


Corneoplastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, United Kingdom


We retrospectively collected data from January 2010 to August 2014 with more than one year follow up. We performed epithelium disruption technique and for corneal thickness more than 450 microns we used isotonic Riboflavin 0.1%, for less than 450 microns hypotonic Riboflavin 0.1%, and without treatment for corneal thickness less than 330 microns. UVA irradiation lasted 30 minutes. Silt lamp examination and corneal topography preoperatively and at 6 and 12 months, then yearly postoperatively.Postoperatively patients used fluorometholone 4 times daily (longer if haze persists), chloramphenicol 4 times daily.Efficacy was observed on the basis of maximal keratometry (Kmax), corrected distance visual acuity (CDVA), manifest refraction, corneal thicknessSafety was observed on the basis of loss of CDVA of more than 2 lines, any complication.


We treated 75 eyes (44 children), and from that 59 eyes (34 children) were followed up more than one year. Mean age of children was 14.9 years (range 9-18). Maximal keratometry (Kmax) regressed by ≥ 1 D in 39.1% children, in 41.3% children remained stable, and progressed by ≥ 1 D in 19.6% children. Median difference in Kmax was +0.50 D (mean +1.3±3.3.D). 56.5% of children gain ≥ 2 lines CDVA, and 2.2% children (1 child) lost ≥ 2 lines CDVA due to the progression of keratoconus. 50% of children gained ≥2 lines in UCVA. Nine eyes retreated, none of them needed 3rd treatment after one year. Progression of keratoconus continued in 19.6% patients. 38.9% had Kmax 65 D or more. All had varying degrees of haze: cleared in 3/12 months. No sterile or microbial keratitis. No significant difference in endothelial cell count compared to baseline.


Corneal collagen cross-linking with epithelial disruption in pediatric keratoconus is safe and effective. Re-treatment might be required in up to 20% of cases, higher failure with time. If stable by one year then unlikely for keratoconus to progress.

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