Long-Term Outcomes Of Corneal Cross Linking In Pediatric Keratoconus

This study aims to present the long-term outcomes of corneal collagen cross-linking (CXL) in pediatric keratoconus patients.

Barbara Medical Centre for keratoconus and refractive surgery

This retrospective study included pediatric keratoconus patients who underwent corneal collagen cross-linking between 2006 and 2017. Treatment was administered following the original epithelium-off Dresden protocol at 3 mW/cm2 for 30 minutes, with a total dose of 5.4 J/cm2. Clinical evaluation comprised visual acuities, refractive assessments, and Scheimpflug corneal tomography. The study included all patients with a minimum follow-up duration of 5 years.

Fifty-five pediatric patients underwent CXL of which 23 eyes of 13 patients completed follow-up of more than 5 years with average follow-up of 9 years. The mean age at the time of treatment was 15.35 years. Uncorrected distance visual acuity improved from 0.69  to 0.41 logMAR and corrected distance visual acuity improved from 0.26 to 0.09 logMAR (P< 0.0001). The mean manifest refraction spherical equivalent reduced from -1.60D to -1.07D (P=0.0766). Mean flat and steep keratometry values were not significantly altered (P > 0.05 for both), the mean maximum keratometry significantly decreased from 53.88 D preoperatively to 52.43 D (P=0.009). No progression documented during the 9 years average follow-up. No permanent corneal haze was observed.

Long-term follow-up of Dresden protocol CXL in the pediatric keratoconus group proved to be safe and effective in arresting progression of the disease.