Long-term outcomes of corneal cross-linking for keratoconus in pediatric patients

Abstract

To report the long-term outcomes of corneal cross-linking (CXL) in pediatric patients with bilateral progressive keratoconus. The medical records of consecutive pediatric patients with bilateral progressive keratoconus who underwent CXL at a single institution from June 2007to December 2009 were reviewed.All eyes underwent CXL treatment in accordance with the original Dresden protocol.Pre- and post-operative (at 1year and >5years after CXL) examinations included, corneal thickness (CT) at the thinnest point, corneal topographic evaluation (flat, steep meridian keratometry and maximum keratometry), with manifest refraction and corrected distance visual acuity. A total of 20 eyes of 10 patients were included. Mean age at time of CXL was 14.34±2.14years (range, 10.49-17.09years). Mean follow-up was 7.63±1.31years (range, 5.41-9.34years). No intra- or postoperative complications were observed. Stabilization of all topographic indices (steep K, flat K, Kmax, and topographic cylinder) was demonstrated throughout the follow-up period (compared to preoperative topographic indices [P<0.05]). Mean corrected distance visual acuity improved to 0.14±0.16 logMAR at final follow-up from the preoperative values 0.28±0.17 logMAR (P>0.05); none of the eyes lost corrected distance visual acuity lines. Manifest refraction and mean corneal pachymetry at the thinnest point remained stable throughout the follow-up (P<0.05). In this case series CXL (Dresden protocol) for pediatric keratoconus halted disease progression and offered improved visual function up to 7.5years after treatment.