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  • Accelerated CXL appears safe, effective for progressive keratoconus in children

    Cornea/External Disease, Pediatric Ophth/Strabismus, Refractive Mgmt/Intervention

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    Review of: Three-year follow-up of accelerated transepithelial corneal cross-linking for progressive paediatric keratoconus

    Tian M, Jian W, Zhang X, et al. British Journal of Ophthalmology, October 2020

    This retrospective, interventional case series evaluated the long-term safety and efficacy of accelerated transepithelial corneal crosslinking (CXL) in pediatric eyes with progressive keratoconus.

    Study design

    Researchers assessed 53 eyes of 41 patients aged 10 to 17 years who underwent accelerated CXL for progressive keratoconus. Diagnoses were based on the global consensus on keratoconus and ectatic disease criteria. Inclusion criteria included patients with thinnest corneal thickness of 400 μm or more. Disease progression was defined as an increase in maximum keratometry (Kmax) of 1 D or more in 1 year.

    Outcomes

    At 36 months, CDVA improved from 0.32 to 0.26 logMAR (P=0.025). Both Kmax and corneal central thickness remained relatively stable during the 36-month follow-up (both P>0.05). Posterior central elevation and posterior highest elevation were stable at 12 months, but increased at 36 months (P<0.05). Maximum keratometry increased by 1 D or more in 9.3% and 20% of eyes at 1 year and 3 years, respectively.

    Limitations

    The Kmax reported in this study compares unfavorably relative to other studies of conventional CXL.

    Clinical significance

    Accelerated transepithelial corneal CXL is a novel modification of conventional CXL that maintains the integrity of the corneal epithelium, allowing for an easier procedure and recovery in children. However, long-term efficacy requires direct, prospective comparison to conventional CXL.