Pediatric Crosslinking: Current Protocols and Approach

Area of Science:

• Ophthalmology
• Corneal Surgery
• Pediatric Eye Care

Background:

• Pediatric keratoconus (KC) often presents more aggressively than in adults, increasing the risk of visual impairment.
• Corneal crosslinking (CXL) is a primary treatment to halt KC progression.
• Numerous CXL variations exist, necessitating a review of their pediatric efficacy and safety.

Purpose of the Study:

• To provide an updated literature review on corneal crosslinking (CXL) techniques for pediatric keratoconus (KC).
• To analyze the safety, efficacy, risks, and cost-effectiveness of current and emerging CXL methods in children.
• To identify the optimal CXL approach for the pediatric KC population.

Main Methods:

• Systematic review of English-language literature indexed in PubMed.
• Analysis of various CXL protocols: Standard CXL (SCXL), Accelerated CXL (ACXL), Transepithelial CXL (TCXL).
• Inclusion of novel techniques like contact lens-assisted CXL (CACXL), epithelial-island CXL (EI-CXL), and the Sub400 protocol, alongside riboflavin carrier variations (dextran-based vs. HPMC-based).

Main Results:

• Standard CXL (Dresden Protocol) demonstrates safety and effectiveness in pediatric KC.
• Accelerated CXL offers similar efficacy with reduced treatment time.
• Transepithelial CXL aims to minimize complications and patient discomfort.
• Emerging techniques address challenges with thinner corneas and offer alternative approaches.

Conclusions:

• While several CXL techniques show promise for pediatric KC, definitive evidence on the safest and most effective method is still evolving.
• Further research is needed to compare the long-term outcomes, safety profiles, and cost-effectiveness of different CXL protocols in pediatric patients.
• Understanding the nuances of each CXL approach is crucial for optimizing treatment strategies in young KC patients.