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  • Corneal Cross-Linking Shows Positive Long-Term Results for Pediatric Keratoconus

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

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    Review of: Corneal collagen cross-linking for progressive keratoconus in pediatric patients: Up to 14 years of follow-up

    Vinciguerra R, Bordignon N, Ferraro V, et al. American Journal of Ophthalmology, November 2023

    More than 10 years after undergoing corneal cross-linking (CXL), a cohort of pediatric patients with progressive keratoconus maintained significant improvements in visual acuity as seen at 12 months postoperatively and achieved long-term structural stability of corneal tissue.

    Study design

    This was a retrospective, single-center study evaluating pediatric patients (<18 years of age) who underwent CXL for progressive keratoconus according to the Dresden protocol between June 2007 and January 2011 and who had at least 10 years of follow-up data. The researchers documented corrected distance visual acuity (CDVA) and tomography at baseline and compared it to data gathered ≥10 years after CXL. Progression was defined as having 2 of the following 3 findings on ABCD analysis at the long-term visit: worsening of A values (steepening of the anterior corneal curvature), worsening of B values (steepening of the posterior corneal curvature), or a decrease in C (corneal thinning).

    Outcomes

    The final analysis included 38 eyes from 24 patients with a mean age of 14.9 years. Significant improvements were seen at a mean of 11.6 years after CXL, with CDVA improving from 0.703 to 0.887 and the A value improving from 2.55 to 1.63. While 34% of eyes demonstrated progression of disease in 2 of the 3 parameters, only 7.9% of all eyes showed progression that included a statistically significant worsening in anterior curvature. No significant adverse events were reported.

    Limitations

    Limitations of this study include the small number of patients included, retrospective design, and single-center approach. Further longer-term prospective studies including multiple centers would be helpful to better understand and generalize these findings.

    Clinical significance

    The results of this study suggest that corneal cross-linking is a safe and effective treatment for keratoconus in pediatric patients. Nonetheless, especially since CXL has only been used in clinical practice within the last two decades, pediatric patients treated with CXL should continue to be followed long term to document any recurrence of progression.

    Financial Disclosures: Dr. Zeba Syed discloses financial relationships with Recordati Rare Diseases (Consultant/Advisor, Lecture Fees/Speakers Bureau); Dompe, Glaukos Corporation (Grant Support); Bio-Tissue (Lecture Fees/Speakers Bureau).