Corneal Cross-Linking for Pediatric Keratoconus: Long-Term Results

• Published in: Cornea Vol. 35; no. 7; p. 954
• Main Authors: Godefrooij, Daniel A, Soeters, Nienke, Imhof, Saskia M, Wisse, Robert P L
• Format: Journal Article
• Language: English
• Published: United States 01.07.2016
• Subjects: Adolescent; Child; Cohort Studies; Collagen - metabolism; Corneal Stroma - metabolism; Cross-Linking Reagents; Female; Follow-Up Studies; Humans; Keratoconus - drug therapy; Keratoconus - metabolism; Keratoconus - physiopathology; Male; Photochemotherapy; Photosensitizing Agents - therapeutic use; Prospective Studies; Riboflavin - therapeutic use; Ultraviolet Rays
• DOI: 10.1097/ICO.0000000000000819

To assess the efficacy and safety of cross-linking in pediatric patients with keratoconus and to provide a systematic literature overview regarding this subject. In this prospective cohort, 54 eyes of 36 pediatric patients with keratoconus underwent standard epithelium-off cross-linking. Follow-up measurements taken up to 5 years after treatment were compared with baseline values. Logistic regression was used to identify the underlying cause in case of progression despite treatment. Finally, a systematic search was performed in PubMed and Embase, and data were extracted and summarized. At all follow-up visits up to 5 years, maximum keratometry values improved significantly (mean change at 5 years -2.06 diopters (D), P = 0.01); moreover, average keratometry, uncorrected distance visual acuity, and corrected distance visual acuity improved at all follow-up times, though not always to the level of statistical significance. In 12 eyes (22%), keratoconus had progressed by ≥1.0 D by the last follow-up visit, despite corneal cross-linking. Cones that were more decentralized were identified as the underlying cause of disease progression. The systematic search yielded 17 unique articles: 10 articles on epithelium-off cross-linking, 2 on accelerated cross-linking, 2 on transepithelial cross-linking, 1 on both epithelium-off and transepithelial cross-linking, and 2 on transepithelial cross-linking with iontophoresis. Our long-term follow-up reveals that epithelium-off cross-linking is both apparently safe and effective when used to prevent keratoconus progression in pediatric patients. However, disease progression occurred in 22% of the treated eyes; this progression was attributed to a more decentralized cone location.