Skip to main content
  • CXL Halts Keratoconus Progression in Children

    By Lynda Seminara
    Selected by Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, November 2021

    Download PDF

    Larkin et al. assessed the efficacy and safety of corneal cross-linking (CXL) in slowing keratoconus progression in children. They found that, compared with standard care alone, adjunctive CXL resulted in flatter corneas and better visual acuity (VA).

    For this study, known as Keralink, the researchers included patients aged 10 to 16 years who were experiencing progressive keratoconus. One eye of each patient was designated as the study eye. Each study eye was assigned randomly to receive CXL plus standard care (CXL group) or standard care only (control group). Standard care was defined as spectacle or contact lens correction to improve vision. The primary outcome measure was steep keratometry (K2) in the study eye 18 months after randomization. Key sec­ondary outcomes included keratoconus progression (defined as an increase of 1.5 D in K2) as well as uncorrected and corrected VA.

    Overall, 58 eyes (58 patients) were analyzed, with 28 in the control group and 30 in the CXL cohort. Mean K2 at 18 months was 49.7 D in the CXL group (standard deviation [SD], 3.8 D) and 53.4 D in controls (SD, 5.8 D). The adjusted mean K2 difference was –3.0 D (p = .002), favoring CXL treatment. Similarly, the adjusted between-group differences in uncorrected and corrected VA favored CXL: –0.31 logMAR and –0.51 logMAR, respectively (both p = 0.002). Kerato­conus progressed in two CXL-treated eyes (7%) and in 12 control eyes (43%). The unadjusted odds ratio (0.1) suggests that the likeli­hood of disease progression was 90% lower in the CXL group (p = .004).

    In light of these findings, CXL may merit consideration as a first-line treatment option for young patients with progressive keratoconus, the authors said.

    Additionally, the authors hypothe­sized that if “the arrest of keratoconus progression induced by CXL is sus­tained in longer follow-up, particular benefit may be derived from avoiding a later requirement for contact lens wear or corneal transplantation.”

    The original article can be found here.