Corneal Cross Linking with Riboflavin for Progressive Keratoconus in Paediatric Eyes

Purpose: To report visual, refractive and topographic outcomes after corneal collagen crosslinking (CXL) for progressive keratoconus in paediatric eyes. Methods: In this prospective interventional study, twenty eyes of eighteen patients with progressive keratoconus were included. All eyes underwent CXL with riboflavin after documented progression of the disease. Informed, written consent was taken from the parents of the patients. The patients were followed up for 6 months. Complete ophthalmic examination and Scheimpflug imaging were performed at each visit. Reduction of the mean refractive cylinder, and corneal flattening were the main outcome measures. Results: The mean age of the patients was 13.55 years, (range: 9 - 16 yrs). The mean refractive cylinder reduced from a preoperative value of -5.26D to -4.66D (p = 0.10), -4.31D (p = 0.009), and, -4.10D (p = 0.003) at one, three and six months (postoperative) respectively. The mean average K value increased from 51.88D to 52.18D (p = 0.64) at one month postoperatively and reduced thereafter to 51.28D (p = 0.32) and 51.54D (p = 0.02) at three and six months respectively. Thinnest pachymetry reduced very significantly from a mean preoperative value of 459.15 μm to 400.8 μm (p < 0.001), 405.9 μm (p < 0.001) and 413.6 μm (p < 0.001) postoperatively at one, three and six months respectively. Best corrected visual acuity (decimal units) improved insignificantly from a preoperative value of 0.43 to 0.49 (p = 0.42) at six months postoperatively. Conclusion: Short term results of corneal collagen crosslinking with riboflavin for progressive keratoconus in children are promising in terms of reduction in the mean refractive cylinder and flattening of the cornea, and appears effective in halting the progression of the disease in the paediatric age group. Long term follow up is required to assess the lasting effect of CXL in this age group.