Accelerated corneal crosslinking in children with keratoconus: 5-year results and comparison of 2 protocols

Area of Science:

• Ophthalmology
• Corneal Surgery
• Pediatric Eye Care

Background:

• Keratoconus is a progressive corneal ectasia affecting pediatric patients.
• Corneal crosslinking (CXL) is a standard treatment to halt keratoconus progression.
• Accelerated CXL protocols aim to reduce treatment time while maintaining efficacy.

Purpose of the Study:

• To evaluate the long-term clinical outcomes of two distinct accelerated corneal crosslinking (CXL) protocols in pediatric patients diagnosed with keratoconus.
• To compare the efficacy and safety of different accelerated CXL parameters in a pediatric population.

Main Methods:

• A retrospective case-control study involving pediatric patients (<18 years) with keratoconus.
• Two accelerated CXL groups were analyzed: Group 1 (4 min at 30 mW/cm²) and Group 2 (5 min at 18 mW/cm²).
• Clinical evaluations included visual acuity, refraction, corneal topography, and higher-order aberrations (HOAs) assessed over a 5-year follow-up period.

Main Results:

• No significant progression of keratometry was observed in 76.7% of Group 1 eyes and 83.2% of Group 2 eyes.
• A significant reduction in total HOAs and coma was noted in Group 2 at the 5-year follow-up compared to baseline (P=.005 and P=.045, respectively).
• Group 1 showed no significant topographic changes throughout the follow-up, while Group 2 exhibited a trend towards decreased keratometry (P=.06).

Conclusions:

• Accelerated CXL is a beneficial treatment for halting keratoconus progression in pediatric patients over a 5-year period.
• The protocol with higher irradiance and reduced application time (Group 1) demonstrated fewer topographic alterations, suggesting a potentially more favorable profile for pediatric keratoconus management.