Adolescent keratoconus patients should be monitored for progression after CXL

Investigators report the long-term results of accelerated corneal collagen crosslinking (CXL) treatment in adolescent patients with progressive keratoconus.

Study design

The retrospective study included 35 eyes of 23 patients aged 14 and younger and in the pubertal period. They underwent epi-off accelerated CXL and were followed for at least 4 years postoperatively.

Outcomes

At 1 year, central corneal thickness (CCT) and thickness of thinnest point of the cornea (TTPC) were significantly decreased from preoperative values (P=0.02 and P=0.003, respectively). At the 2-year follow-up, however, only TTPC remained decreased from baseline (P=0.01).

At the last follow-up visit, the average CCT was significantly increased (P=0.04) and 7 eyes (20%) showed keratometric progression. Of these eyes, 2 were in stage 1, and the remaining 5 were in stage 2 at presentation.

Limitations

This study was retrospective and included patients with a range of disease severity. At presentation, 31% were classified as stage 1 keratoconus, 40% were stage 2, 23% were stage 3 and 6% were stage 4.

Clinical significance

Despite stable best-corrected visual acuity, progression of keratoconus occurred in 20% of pubertal patients within 4 to 5 years after undergoing epi-off CXL. At the last visit, progression was found to be associated with preoperative K1, K2, CCT, TTPC and age.