Mini Asymmetric Radial Keratotomy and Corneal Cross-linking for the Treatment of a Bilateral Stage IV Keratoconus in a 14-year-old Child.

Aim: To present the case of a 14-year-old boy with bilateral stage IV keratoconus, treated with a combined MARK + CXL intervention, without the need for a corneal transplantation.

Results: The left eye displays considerable improvements, with a follow-up of 13.5 years: Kmax is decreased by 5.53 D, Kmed is decreased by 1.95 D and thinnest pachymetry is increased by 106 µm. The right eye shows equally remarkable parameters, with a follow-up of 9.5 years: Kmax is decreased by 8.16 D, Kmed is decreased by 0.38 D and thinnest pachymetry is increased by 52 µm. Keratoconus has been halted and the patient has a binocular best corrected visual acuity of -0.079 LogMAR (12/10).

Conclusion: The MARK + CXL combined intervention, known as the "Rome Protocol", was successful in halting a bilateral stage IV keratoconus and improving visual acuity in a very young patient, with long-term follow-up. Conservative treatments should always be privileged when treating very young patients with developed stages of the pathology.