A protocol for treating keratoconus in children can include corneal crosslinking

Cornea/External Disease, Pediatric Ophth/Strabismus

Corneal crosslinking (CXL) appears to show long-term effectiveness in slowing keratoconus progression in a pediatric population.

Study design

A longitudinal study assessed the efficacy and safety of CXL in 58 pediatric patients (aged ≤18 years) who underwent CXL for progressive keratoconus at a single center in Brazil. In addition, the study compared the use of 20% dextran-based riboflavin and 1% hydroxypropyl methylcellulose (HPMC)–based riboflavin. Primary outcomes included changes in uncorrected and corrected visual acuity over the 7-year follow-up period.


Long-term improvements in visual acuity were seen with both dextran- and HPMC-based riboflavin. Vision was either stable or improved in 82% of the eyes; failure to decrease keratoconus progression was seen in only 11% of eyes. No serious adverse events were reported.


Fewer patients were given dextran-based riboflavin than HPMC-based riboflavin, even though the former is more commonly used. Additional studies are required to determine the best protocol in children undergoing CXL.

Clinical significance

Corneal crosslinking decreased the progression of keratoconus in the majority of patients’ eyes. Importantly, CXL stabilized, if not improved, visual acuity in children. Early detection of keratoconus and access to CXL for pediatric patients is essential.

Financial Disclosures: Dr. Brenda Bohnsack discloses no financial relationship.

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