Outcomes of accelerated corneal cross-linking for pediatric and adult keratoconus: a comparative study.

Abstract

To compare the visual, refractive, and topographic outcomes of a high irradiance accelerated corneal crosslinking (ACXL) protocol after a 12-month follow-up between pediatric and adult patients with progressive keratoconus (KC). Retrospective, comparative, cohort study. Patients with KC were divided into two groups: pediatric (≤ 18years) and adult (> 18years). All of them were managed with epi-OFF ACXL (30mW/cm2, 8min, pulsed 1:1 on and off = 7.2J/cm2). Visual, refractive, and topographic values were measured preoperatively and at 1, 3, 6, and 12months postoperative. KC progression, defined as a Kmax increase of ≥ 1D during follow-up, was recorded. Eighty-nine eyes (53 patients) were included for analysis; 45 (50.6%) eyes were from pediatric patients and 44 (49.4%) from adults. At one-year follow-up, pediatric patients experienced significantly higher rates of progression (22.2% vs. 4.5%, p = .014). Contrariwise, female gender (Beta = - 3.62, p = .018), a baseline uncorrected visual acuity of Snellen ≥ 20/60 (Beta = - 5.96, p = .007), and being ≥ 15years at ACXL treatment (Beta = - 0.31, p = .021) were associated with non-progressive disease. A significant improvement in best-corrected visual acuity, Kmin, Km, and Kmax was recorded in both groups. Overall, 86.5% of eyes from both groups showed Kmax stabilization or improvement. Despite the similarity in visual, refractive, and topographic outcomes in both groups, younger age was associated with KC progression after ACXL at one year of follow-up.