Clinical, Topographic And Progression Outcomes After Crosslinking In Pediatric Patients

To describe clinical and topographic outcomes following crosslinking in a cohort of pediatric patients in a national reference center in Guatemala. 

Cornea, Cataract and Refractive Surgery Clinic, Unidad Nacional de Oftalmología, Guatemala City

Retrospective study analyzed patients ≤18yo, who underwent accelerated corneal crosslinking (CXL) with VarioCXL® (Peschke, Switzerland) for keratoconus during 2024-2025. Clinical and topographic characteristics were evaluated before and 6mo after the procedure. Best-corrected visual acuity and history of ocular atopy were measured also the Pentacam AXL® (Oculus, Germany) was used to evaluate curved and flat keratometry (K1, K2), maximum keratometry (Kmax), central corneal thickness (PACHY), and keratometric astigmatism, and the ABCD Belin progression index. The type of procedure (CXL epi on/off), associated complications, and progression rates were calculated. Reduced logistic regression analysis was performed for progression prediction.

83 eyes from 44 patients were analyzed, mean age of 14.8 yo, 46% male. 87% had a history of atopy; Epi-Off CXL performed in 75.3% of patients. No statistically significant changes were observed in visual acuity (p=0.89), KMAX(p=0.36), or PACHY(p=0.699) 6 months after the procedure. Progression rates varied according to the definition: 1D change in KMAX 14%; 10 µm decrease in PACHY 11%; and change in the ABCD index 14%. Logistic regression analysis did not identify age, sex, history of atopy, or CXL type, as factors that significantly influenced progression. Although a trend toward greater progression was observed in eyes with high preoperative KMAX values, this did not reach statistical significance. No complications were reported. 

Significant clinical and topographic stabilization was observed at 6 months. Progression rates were low according to the various criteria assessed. In logistic regression models, none of the demographic, baseline clinical, or procedural variables were independently associated with progression. Our results suggest that crosslinking, whether epi-off or epi-on, is a safe and effective treatment to arrest progression, with clinical risk factors not significantly affecting the probability of success. Future studies with larger samples and long-term follow-up are needed to confirm these findings and the decision to perform crosslinking when diagnosing keratoconus in children. A consensus on the definition of progression is still needed.