Corneal Collagen Cross-Linking for Progressive Keratoconus in Pediatric Patients: Up to 14 Years of Follow-up

PURPOSE: To assess the long-term outcomes of corneal collagen cross-linking according to the Dresden protocol (S-CXL) in progressive pediatric keratoconus (KC). DESIGN: Retrospective, single-center noncomparative interventional study. METHODS: Patients aged <18 years who underwent S-CXL from June 2007 to January 2011 in Humanitas Clinical and Research Center, Rozzano, Milan, Italy, and completed at least 10 years of follow-up were included. Corrected distance visual acuity (CDVA), refraction, and tomography were evaluated at baseline and ≥10 years after S-CXL. Meeting 2 of the following 3 criteria indicated reprogression: progression above 95% CI for post-CXL population of A or B values or a decrease in minimal thickness C evaluated with the ABCD display. RESULTS: Thirty-eight eyes of 24 patients fulfilled inclusion criteria. At a mean of 11.6 years postoperation (maximum 14 years), the CDVA improved significantly (from 0.703 ± 0.33 decimal fraction to 0.887 ± 0.2, P < .001). Similarly, the A value significantly improved from 2.550 ± 1.7 to 1.627 ± 1.68 (P = .019). Thirteen eyes (34%) showed significant postoperative progression in 2 of the 3 parameters A, B, and C. Of these, only 3 eyes (7.9%) of 3 patients showed a statistically significant change in the A value. CONCLUSIONS: S-CXL proved to be a safe treatment for progressive KC in pediatric patients with an anterior curvature progression rate of up to 7.9% at ≥10 years of follow-up.