A Retrospective Analysis Comparing The Outcomes Of Standard And Accelerated Crosslinking In Paediatric Patients With Keratoconus

To compare the outcomes of standard and accelerated crosslinking in paediatric patients with keratoconus

Tertiary referral centre at Guy's and St Thomas' NHS Foundation Trust, London

A retrospective review of 60 eyes of 38 paediatric patients who underwent crosslinking (CXL) for keratoconus between October 2018 and July 2024. Patients with a minimum follow up of 6 months were included. Pentacam (Oculus, Wetzlar, Germany) data K1 (front), K2 (front), K2 (back), Kmax, thinnest pachymetry and best-corrected visual acuity (BCVA) were collected. The outcomes were analysed based on the topographical keratoconus classification (TKC), the crosslinking protocol used and the longest duration of follow-up data available.

The mean follow-up duration was 26.00 (SD 16.41, range 6-71) months.
In eyes with mild keratoconus (TKC stage 0 and 1), the mean change in K2 and Kmax in the standard (n=7) and accelerated (n=5) CXL group was ΔK2 –0.86 (SD 0.72), 0.04 (SD 0.32) and ΔKmax -1.20 (SD 2.00), -0.14 (SD 0.29) with a significant difference in ΔK2 (p<0.05) favouring standard crosslinking but no significant difference in ΔKmax (p>0.05).
In eyes with moderate to advanced keratoconus (TKC stage 2, 3 and 4), the mean change in K2 and Kmax in the standard (n=34) and accelerated (n=14) CXL group was ΔK2 -0.52 (SD 4.14), 0.62 (SD 2.38) and ΔKmax -1.66 (SD 5.66), -0.09 (SD 3.67) with no significant difference between the groups (p>0.05).

Based on topographical parameters, standard and accelerated crosslinking are safe and effective procedures to achieve stability and halt keratoconus progression in paediatric patients.  There may be small differences in topographical parameter changes post standard and accelerated protocols. High powered studies are required to investigate this further.