Transepithelial corneal collagen crosslinking for progressive keratoconus in a pediatric age group

PURPOSE: To evaluate the effectiveness and safety of transepithelial corneal collagen crosslinking (CXL) in children with keratoconus and the refractive changes induced by this treatment. SETTING: Ophthalmology Department, Ain-Shams University Hospitals, Cairo, Egypt. DESIGN: Prospective comparative case series. METHODS: Patients younger than 18 years with bilateral keratoconus had transepithelial CXL with the use of transepithelial riboflavin. The other eye was used as a control and was treated conservatively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and corneal tomography at 12 months were the main outcome measures. RESULTS: The mean age of the 22 patients (22 eyes) was 15.7 years +/- 2.1 (SD). After transepithelial CXL, the improvement in the mean UDVA was statistically significant (from 0.95 +/- 0.34 logMAR to 0.68 +/- 0.45 logMAR) (P<.05). No eye lost lines of preoperative UDVA; 1 eye lost 1 line of preoperative CDVA. There was no improvement in the control group in UDVA or CDVA (P>.05). The mean simulated keratometry (K) decreased by a mean of 2.03 diopters (D), with mean flattening of the apical K by 2.20 D; both results were statistically significant (P<.05). In the control group, the simulated K increased by a mean of 0.59 D (P>.05), with mean steepening of the apical K by 2.9 D (P<.05). No significant changes occurred in the endothelial cell count in either group. CONCLUSION: Preliminary results of transepithelial CXL in children with keratoconus were encouraging, with no evidence of progression of keratoconus over 12 months.