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Promising long-term results of corneal collagen-crosslinking in pediatric cases of progressive keratoconus

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


What are the key takeaway points from this article? 

Keratoconus is a corneal disorder where progressive corneal thinning and surface irregularity can cause significant visual distortion and vision loss. Pediatric cases of keratoconus are typically aggressive in its clinical course and diagnosed at advanced stages compared to adult cases. This single-centre retrospective study aimed to assess long-term outcomes of corneal cross-linking (CXL) according to the Dresden protocol in a cohort of pediatric patients (<18 years of age) with progressive keratoconus. Corrected distance visual acuity (CVDA), refraction and tomography were established at baseline and compared to follow up data between 10-14 years post-CXL. Progression was defined as meeting 2 of the 3 criteria based on the ABCD Pentacam analysis at the long-term follow-up visit. These 3 parameters included steepening of the anterior corneal curvature (A value), steepening of the posterior corneal curvature (B value) (values above the 95% CI), and corneal thinning (C value).

Inclusion criteria was met in 38 eyes of 24 patients (mean age 14.9 ± 2.2 years). At a mean follow-up of 11.6 years post-CXL, there were statistically significant improvements in the CDVA and the A value from 0.703 decimal fraction to 0.887 (P < .001), and from 2.550 to 1.627 (P = .019) respectively. There was no significant change in refraction. Of the 38 eyes, 13 eyes (34%) demonstrated significant progression in 2 of the 3 parameters. However, only 3 eyes (7.9%) revealed statistically significant progression of the anterior curvature (A value).

Though this study is limited by its retrospective nature and small-sample size, it supports the safety profile and effectiveness of CXL in pediatric cases of progressive keratoconus. Importantly, there was a significant improvement in visual acuity with clinical stability ≥10 years with no adverse events reported. 

Publication Date: July 2023


Vinciguerra R, Bordignon N, Ferraro V, Mazzotta C, Rosetta P, Vinciguerra P. Corneal collagen cross-linking for progressive keratoconus in pediatric patients: Up to 14 years of follow-up. Am J Ophthalmol. 2023;255:170-177. doi:10.1016/j.ajo.2023.07.017

Summary by: Brooklyn Rawlyk


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