Corneal Collagen Cross-linking for Progressive Keratoconus in Pediatric Patients: A Feasibility Study

Abstract

To evaluate the outcomes of corneal collagen cross-linking (CXL) in pediatric patients with bilateral progressive keratoconus. This retrospective case series included four pediatric patients (eight eyes) with progressive keratoconus aged 14.0±2.2 years (range: 11 to 16 years). All eyes underwent CXL in accordance with the standard Dresden protocol. Pre- and 1-, 12-, 24-, and 36-month postoperative examinations included corneal thickness at the thinnest point (using a topographic system), corneal topographic evaluation (flat and steep meridian keratometry [K1 and K2]), refraction, and visual acuity. All patients completed 36-month follow-up. No intra- or postoperative complications were observed. Stabilization of K1 and K2 was demonstrated in all cases throughout follow-up (from the first postoperative interval), while visual acuity improved in six eyes and remained stable in the remaining two eyes. Manifest refraction remained stable, and corneal thickness decreased at the first postoperative month with gradual return to preoperative values during follow-up. Preliminary data of four pediatric patients with moderate keratoconus show feasibility of treatment by CXL in these select patients with no intra- or postoperative complications over 3-year follow-up.