Long-term outcomes of corneal cross-linking for keratoconus in pediatric patients.

Purpose: To report the long-term outcomes of corneal cross-linking (CXL) in pediatric patients with bilateral progressive keratoconus.

Methods: The medical records of consecutive pediatric patients with bilateral progressive keratoconus who underwent CXL at a single institution from June 2007to December 2009 were reviewed. All eyes underwent CXL treatment in accordance with the original Dresden protocol. Pre- and post-operative (at 1 year and >5 years after CXL) examinations included, corneal thickness (CT) at the thinnest point, corneal topographic evaluation (flat, steep meridian keratometry and maximum keratometry), with manifest refraction and corrected distance visual acuity.

Results: A total of 20 eyes of 10 patients were included. Mean age at time of CXL was 14.34 ± 2.14 years (range, 10.49-17.09 years). Mean follow-up was 7.63 ± 1.31 years (range, 5.41-9.34 years). No intra- or postoperative complications were observed. Stabilization of all topographic indices (steep K, flat K, Kmax, and topographic cylinder) was demonstrated throughout the follow-up period (compared to preoperative topographic indices [P < 0.05]). Mean corrected distance visual acuity improved to 0.14 ± 0.16 logMAR at final follow-up from the preoperative values 0.28 ± 0.17 logMAR (P > 0.05); none of the eyes lost corrected distance visual acuity lines. Manifest refraction and mean corneal pachymetry at the thinnest point remained stable throughout the follow-up (P < 0.05).

Conclusions: In this case series CXL (Dresden protocol) for pediatric keratoconus halted disease progression and offered improved visual function up to 7.5 years after treatment.