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Outcomes of accelerated corneal cross-linking for pediatric and adult keratoconus: a comparative study

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Abstract

Purpose

To compare the visual, refractive, and topographic outcomes of a high irradiance accelerated corneal crosslinking (ACXL) protocol after a 12-month follow-up between pediatric and adult patients with progressive keratoconus (KC).

Methods

Retrospective, comparative, cohort study. Patients with KC were divided into two groups: pediatric (≤ 18 years) and adult (> 18 years). All of them were managed with epi-OFF ACXL (30 mW/cm2, 8 min, pulsed 1:1 on and off = 7.2 J/cm2). Visual, refractive, and topographic values were measured preoperatively and at 1, 3, 6, and 12 months postoperative. KC progression, defined as a Kmax increase of  ≥ 1D during follow-up, was recorded.

Results

Eighty-nine eyes (53 patients) were included for analysis; 45 (50.6%) eyes were from pediatric patients and 44 (49.4%) from adults. At one-year follow-up, pediatric patients experienced significantly higher rates of progression (22.2% vs. 4.5%, p = .014). Contrariwise, female gender (Beta = − 3.62, p = .018), a baseline uncorrected visual acuity of Snellen ≥ 20/60 (Beta = − 5.96, p = .007), and being ≥ 15 years at ACXL treatment (Beta = − 0.31, p = .021) were associated with non-progressive disease. A significant improvement in best-corrected visual acuity, Kmin, Km, and Kmax was recorded in both groups. Overall, 86.5% of eyes from both groups showed Kmax stabilization or improvement.

Conclusions

Despite the similarity in visual, refractive, and topographic outcomes in both groups, younger age was associated with KC progression after ACXL at one year of follow-up.

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Authors and Affiliations

  1. Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio #112. Col. Real de San Agustin, CP. 66278, Monterrey, N.L., Mexico

    Andres Bustamante-Arias, Julio C. Hernandez-Camarena, Alejandro Rodriguez-Garcia, Raul E. Ruiz-Lozano, Luis A. Rodriguez-Gutierrez & Jorge E. Valdez-Garcia

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  1. Andres Bustamante-Arias
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Contributions

ABA, JCHC, and JEVG participated in the study design. RERL and LARG collected the data. ABA and JCHC participated in the analysis of data. JCHC, ARG, and JEVG participated in the clinical management of the patients enrolled in the study. ABA and RERL wrote the main manuscript text and created the tables. JCHC, ARG, and JEVG edited the manuscript. JCHC, ARG, and JEVG supervised the work. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jorge E. Valdez-Garcia.

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Competing interests

The authors declare no competing interests.

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The authors declare no conflicts of interest nor financial disclosures.

Availability of data and material

Data of this study is available upon request from the corresponding author. The data are not publicly available because the study was approved under informed consent for research purposes, protecting their privacy, prohibiting sharing information with third parties according to the Mexican General Law for the Protection of Personal Data in Possession of Obliged Parties.

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The Ethics (License No. P000474-CXLPED-CEIC-CR001) and Research (License No. P000474-CXLPED-CI-CR001) Committees of our institution (License No. CONBIOETICA 19-CEI-011-2016-10-17 and COFEPRIS 20-CI-19-039-002, respectively), previously approved the study following the tenets of the Declaration of Helsinki.

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Participants and legal tutors of underage (≤ 18 years) patients provided written informed consent.

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Bustamante-Arias, A., Hernandez-Camarena, J.C., Rodriguez-Garcia, A. et al. Outcomes of accelerated corneal cross-linking for pediatric and adult keratoconus: a comparative study. Int Ophthalmol 44, 145 (2024). https://doi.org/10.1007/s10792-024-03080-2

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