Efficacy of Corneal Cross-Linking in the Treatment of Pediatric Keratoconus: A Retrospective Interventional Study

Corneal collagen cross-linking (CXL) has emerged as a promising technique to strengthen corneal biomechanics and arrest ectatic progression, particularly with the standard epithelium-off (epi-off) protocol. This study aimed to evaluate the efficacy and safety of standard epithelium-off corneal collagen cross-linking (SCXL) in halting or reducing the progression of keratoconus in pediatric patients, with particular emphasis on changes in corneal curvature, visual acuity, corneal thickness, and postoperative complications. A retrospective observational study was conducted at the Ophthalmology Department, Damietta Faculty of Medicine, Al-Azhar University, including ۴۰ eyes of ۲۰ pediatric patients (aged ۸–۱۸ years) with progressive keratoconus who had previously undergone standard epi-off CXL. Clinical data were collected from medical records, including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, corneal tomography, pachymetry, and keratometry at baseline and follow-up visits. The primary outcome was the change in maximum keratometry (Kmax) at ۱۲ months, while secondary outcomes included BCVA, corneal thickness, and postoperative complications. At the ۱۲-month follow-up, mean Kmax showed a statistically significant reduction from baseline (p < ۰.۰۵), indicating corneal flattening and stabilization of ectatic progression in more than ۹۰% of treated eyes. BCVA demonstrated significant improvement, with an average gain of approximately ۰.۰۷ logMAR (p < ۰.۰۵). Postoperative corneal thinning was minimal, with no cases exceeding safety thresholds. Transient corneal haze was observed in a small number of eyes and resolved within ۳–۶ months under conservative treatment. No instances of infectious keratitis or persistent epithelial defects were reported. In conclusion, standard epithelium-off corneal collagen cross-linking is an effective and safe treatment for pediatric keratoconus. It halts disease progression, enhances visual acuity, and induces favorable topographic changes with minimal, self-limiting complications. Early diagnosis and timely intervention remain critical for visual preservation in this vulnerable population.

کلیدواژه ها:

Pediatric keratoconus ، corneal collagen cross-linking ، CXL ، epithelium-off