Progression of keratoconus and efficacy of pediatric [corrected] corneal collagen cross-linking in children and adolescents

J Refract Surg. 2012 Nov;28(11):753-8. doi: 10.3928/1081597X-20121011-01.


Purpose: To study the progression rate of keratoconus and assess the clinical outcome of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A light in children and adolescent patients up to 3 years after treatment.

Methods: Fifty-nine eyes from 42 children and adolescents (aged 9 to 19 years) with confirmed keratoconus were included in this retrospective interventional cohort study. Refraction, slit-lamp examination, Placido-based corneal topography, and Scheimpflug imaging were performed bilaterally in all patients preoperatively and at 6 and 12 months postoperatively. Maximal keratometry readings (Kmax), corrected distance visual acuity (CDVA), corneal thickness, and the keratoconus index (KI) were analyzed. Follow-up was up to 36 months (mean follow-up: 26.3 months [range: 12 to 36 months]).

Results: Fifty-two of the 59 eyes enrolled in this study showed progression, corresponding to a progression rate of 88%. Forty-six eyes were treated by CXL. Maximal keratometry, CDVA, and KI showed significant changes over the follow-up period. However, significant Kmax reduction observed up to 24 months after CXL lost significance at 36 months.

Conclusions: Cross-linking seems to be safe in children and adolescents. Progression of keratoconus occurred in 88%. We propose that awaiting documentation of progression is not mandatory and CXL in children and adolescents should be performed as soon as the diagnosis has been made. However, the effect of arrest of disease progression might not be as long-lasting as in adults and longer follow-up is needed to verify this trend.

MeSH terms

  • Adolescent
  • Child
  • Collagen / metabolism*
  • Corneal Pachymetry
  • Corneal Stroma / metabolism*
  • Corneal Topography
  • Cross-Linking Reagents / therapeutic use*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Keratoconus / diagnosis*
  • Keratoconus / drug therapy*
  • Keratoconus / metabolism
  • Male
  • Photochemotherapy*
  • Photosensitizing Agents / therapeutic use*
  • Refraction, Ocular / physiology
  • Retrospective Studies
  • Riboflavin / therapeutic use
  • Treatment Outcome
  • Ultraviolet Rays
  • Visual Acuity / physiology
  • Young Adult


  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Collagen
  • Riboflavin