The Effectiveness Of Crosslinking In Pediatric Keratoconus: Experience Of The Department

Published 2025 - 43rd Congress of the ESCRS

Reference: PO486 | Type: Free paper | DOI: 10.82333/0r8z-8225

Authors: Dan Reinstein* ¹ , Timothy Archer ² , Joseph Potter ² , Ruchi Gupta ² , Glenn Carp ²

¹Centre Hospitalier National d’Ophtalmologie,Paris,France;London Vision Clinic,London,United Kingdom;Columbia University Medical Center,New York,United States, ²London Vision Clinic,London,United Kingdom

Purpose

Keratoconus (KC) is a progressive, degenerative, asymmetric, and bilateral disease of the cornea, characterized by corneal thinning and protrusion. It is classified as pediatric when it manifests before the age of 18. In young children, it is often severe and progresses rapidly, potentially leading to visual impairment. This highlights the importance of a stabilizing treatment, which should be proposed as a first-line option at the time of diagnosis. Crosslinking (CXL), which uses riboflavin, ultraviolet A (UVA), and oxygen to create covalent bonds between collagen fibrils, thereby increasing corneal stiffness, has proven effective in stabilizing this condition.

Setting

We report the department's experience through a retrospective study conducted in the pediatric ophthalmology department, involving patients who underwent CXL before the age of 18.

Methods

Our study included 126 crosslinked eyes in 90 children (18 of whom underwent CXL in both eyes). Among the studied population, 39% were female, and 61% were male. The average age at diagnosis was 13.3 years (ranging from 4 to 17 years), and the current average age is 16.65 years (ranging from 8.5 to 24 years), with an average follow-up period of 52 months (ranging from 3 to 92 months).

Results

Among the CXL procedures, 97% were performed using the standard Dresden epi-off protocol, while 3% were epi-on.

Before CXL: The average visual acuity was 4.6/10

Mean sphere: -3.82 D

Mean cylinder: -3.03 D

Mean pachymetry: 446 µm

Mean Km: 50 D

Mean Kmax: 56.6 D

At 9 months post-CXL:

Average visual acuity improved to 6.23/10

Mean sphere: -2.7 D

Mean cylinder: -4 D

Mean pachymetry: 429 µm

Mean Km: 50 D

Mean Kmax: 55 D

The progression rate was 11%.

Postoperative complications included:

31% of eyes developed corneal haze

3 patients experienced sterile infiltrates

2 cases of corneal opacity (one central, one paraxial)

Conclusions

Post-CXL keratoconus progression has been described and is linked to very high preoperative Km and Kmax values and also to eye rubbing in pediatric patients. CXL complications are rare, with corneal haze being the most common, followed by sterile infiltrates, abscesses, and corneal opacity.

Pediatric keratoconus tends to be aggressive and progressive in nature, making its management a significant challenge. Early and effective intervention, particularly through CXL, is crucial. Although CXL is not without risks, it allows long-term stabilization of the disease. Managing allergies, preventing eye rubbing, and ensuring clinical and pachymetric follow-ups are essential for maintaining positive outcomes and preventing therapeutic failure.