Paediatric cornea crosslinking current strategies: A review

Area of Science:

• Ophthalmology
• Corneal diseases

Background:

• Keratoconus affects 1 in 2000 people, with higher incidence in Southeast Asians.
• Children present earlier with more severe keratoconus, and eye rubbing is a risk factor.
• Progression in children is rapid, making visual rehabilitation challenging and often requiring early keratoplasty.

Purpose of the Study:

• To evaluate the efficacy of corneal collagen cross-linking (CXL) in halting keratoconus progression in children.
• To compare different CXL protocols, including the Dresden protocol, accelerated CXL, and transepithelial CXL.

Main Methods:

• The Dresden protocol involves central corneal de-epithelialization, riboflavin saturation, and UV-A exposure.
• Accelerated CXL reduces operative time, while transepithelial CXL avoids de-epithelialization.
• Treatment should be preceded by managing vernal keratoconjunctivitis.

Main Results:

• Corneal collagen cross-linking is safe and effective in stopping keratoconus progression in children.
• The Dresden protocol is highly successful but has drawbacks like long operating time and pain.
• Accelerated CXL is equally effective in some studies, and transepithelial CXL is safer but less effective.

Conclusions:

• The Dresden protocol is recommended for halting pediatric keratoconus progression.
• Accelerated CXL is a viable faster alternative.
• Transepithelial CXL offers safety benefits but reduced efficacy for stabilization.