Corneal Cross-Linking for Pediatric Keratoconus

The aim of this study was to evaluate corneal cross-linking (CXL) for keratoconus in pediatric patients.

After keratometric qualification according to the Amsler-Krumeich system, corneal collagen cross-linking was performed using ultraviolet light and photosensitizing riboflavin drops in 111 eyes of 74 children with a mean age of 15 ± 1.67 years. None of the children studied wore contact lenses before the procedure. Visual acuity, intraocular pressure, keratometry, and pachymetry parameters were analyzed before and after corneal cross-linking.

Visual acuity was 0.64 ± 0.31 and 0.66 ± 0.29 before CXL and at the end of the follow-up, respectively; the difference was not statistically significant. The mean intraocular pressure before CXL was 14.48 ± 3.13 mmHg, while the mean value at the end of the follow-up was 14.23 ± 3.03 mmHg; no statistically significant difference was found. Pre- and post-CXL astigmatism was 3.98 ± 2.34 Dcyl and 3.63 ± 1.86 Dcyl, respectively; the difference was not statistically significant. The mean keratometry before CXL was 47.99 ± 3.96 D; the mean post-follow-up value was 47.74 ± 3.63 D. The mean corneal thickness (pachymetry) at the apex of the keratoconus-the thinnest zone of the cornea-before CXL was 492.16 ± 38.75 µm, while the mean value at the end of the follow-up was 479.99 ± 39.71 µm; the difference was statistically significant.

Corneal cross-linking is an effective method for preventing keratoconus progression in children. However, further and detailed ophthalmic follow-up of patients who underwent CXL before the age of 18 is highly advisable.