Pulsed-Light Accelerated Corneal Cross-Linking In Pediatric Keratoconus: Topographic And Refractive Outcomes From A Tertiary Center

To evaluate visual and topographic outcomes after corneal collagen cross-linking (CXL) in a pediatric/adolescent keratoconus cohort using eye-level longitudinal clinical data.

The patient's chart review was conducted at King Khaled Eye Specialist Hospital (a tertiary eye center in Riyadh, Saudi Arabia) between 2014 and 2021.

Retrospective cohort study of 332 eyes from 241 patients undergoing CXL. Outcomes were assessed at last available follow-up and included change in maximum keratometry (Kmax), mean keratometry (Kmean), topographic astigmatism, pachymetry, and uncorrected distance visual acuity (converted to logMAR). Progression was defined a priori as an increase in Kmax of ≥+1.0 D from baseline at last follow-up; improvement was defined as a decrease ≤−1.0 D.

Mean age at treatment was 14.87±3.45 years. Median follow-up was 3.79 years (IQR 2.61). At last follow-up, mean ΔKmax was −0.23±6.66 D. Based on Kmax response categories, 148 eyes (44.6%) improved, 116 (34.9%) were stable, and 58 (17.5%) progressed. Kmax data were available for all eyes at the last follow-up. Repeat CXL was performed in 3 eyes (0.9%). In multivariable GEE analysis, higher baseline Kmax and thinner baseline pachymetry were independently associated with greater corneal flattening at last follow-up (p<0.01).

CXL achieved stabilization or improvement in the majority of pediatric/adolescent eyes over nearly four years of follow-up, with a low retreatment rate. Baseline disease severity and corneal thickness influenced the magnitude of topographic response.