New research suggests corneal collagen crosslinking (CXL) is a safe option for treatment of pediatric keratoconus long-term, but practitioners don’t need to hurry into it without proof of disease progression. A recent study evaluated CXL results in one eye each of 44 pediatric keratoconus patients over a five-year period and compared them with the fellow eye, which was left untreated. Researchers assessed parameters including uncorrected distance visual acuity (UCDVA), best spectacle-corrected distance visual acuity (BCDVA), manifest refraction, pachymetry and corneal topography and tomography.

In five years of follow-up, the treated eyes showed significantly improved UCDVA, as well as significantly reduced manifest cylinder, average keratometry and corneal thickness. There was no significant change in BCDVA or maximum keratometry, and five patients developed mild corneal haze. In the untreated eyes, meanwhile, UCDVA showed a slight but not significant increase while all other parameters remained stable.

“Our long-term follow-up study shows that CXL is a safe procedure in the pediatric age, and during the five-year follow-up period, the fellow untreated eyes did not demonstrate progression,” the study concluded. As such, they believe, “there is no urgency in treating pediatric patients with keratoconus without proof of progression. These patients should be closely monitored for the earliest signs of progression, upon which CXL should be promptly offered.”

Or L, Rozenberg A, Abulafia A, et al. Corneal cross-linking in pediatric patients: evaluating treated and untreated eyes—5-year follow-up results. Cornea. May 3, 2018. [Epub ahead of print].