Corneal collagen crosslinking in children with keratoconus

To report the visual, refractive, and tomographic outcomes of corneal collagen crosslinking (CXL) in pediatric patients with keratoconus.

The medical records of patients ≤ 18 years of age treated with corneal collagen cross-linking from December 2009 to August 2013 were retrospectively reviewed, and the following data were collected at baseline, 3 months, 6 months, and 1 year for all patients and at 2 and 3 years where available: uncorrected- and best-corrected visual acuity, spherical equivalent, cylinder, and tomographic findings.

A total of 25 eyes of 14 patients (11 males) were included. Mean age at surgery was 16.2 ± 1.6 years (range, 13-18). Mean uncorrected visual acuity was 0.53 ± 0.32 logMAR at baseline and 0.46 ± 0.36 logMAR at 1 year (P = 0.07). Mean preoperative best-corrected visual acuity was 0.3 ± 0.26 logMAR, which improved to 0.15 ± 0.12 logMAR at 1 year (P = 0.01). Baseline spherical equivalent and cylinder values were unchanged at 1 year. Mean baseline Kmax, Kmin, and Kmean values were 49.62 ± 4.5 D, 44.68 ± 3.5 D, and 46.3 ± 2.84 D, respectively; these values were stable at 1 year (P > 0.05). At 1 year, compared with preoperative Kmax values, 5 eyes (20%) showed regression; 13 eyes (52%), stabilization; and 7 eyes (18%), progression. There was a significant reduction in the mean thinnest corneal area from baseline (473.6 ± 37.68 μm) to 6 months (424.55 ± 70.2 μm), but this recovered at 1 year (452.82 ± 53.5 μm). There were no significant postoperative complications.

In this patient cohort CXL effectively stabilized uncorrected visual acuity, refractive indices, and keratometry values at 1 year, while improving best-corrected visual acuity.