Corneal Crosslinking Largely Safe in Kids with Thin Corneas

The findings of this study suggest stability in visual acuity with a median increase from baseline to follow-up of three and five logMAR letters in habitual and pinhole visual acuity, respectively. Photo: John Gelles, OD. Click image to enlarge. Keratoconus can be a progressively debilitating ocular disease. The condition tends to worsen mostly in adulthood, but those affected in the pediatric population should be monitored closely and given treatment options to halt progression as much as possible later on. In a new study published in AJO International, researchers wanted to find out if corneal crosslinking (CXL) in pediatric keratoconus patients was safe and effective for those with thin corneas in particular.The retrospective design included 18 children (21 eyes) pulled from the Save Sight Keratoconus Registry used in Australia and New Zealand. All kids who underwent CXL were under the age of 18 and had corneas of 400μm or less. Of these patients, 66.7% were male and the median age was 16. Median follow-up time was 10 months. Median values in outcome measures that changed from baseline to follow-up included a maximum corneal curvature (Kmax) of 70.5D to 69.3D, central steepest corneal curvature (K2) of 60.5D to 58.6D, habitual visual acuity of 47 to 50 logMAR letters, pinhole visual acuity from 55 to 60 logMAR letters and minimum corneal thickness from 390μm to 370.5μm, respectively. Three eyes had adverse events; two developed corneal scarring and one had microbial keratitis which resulted in needing a corneal graft.In the discussion section of their paper, the authors relay that half of the patients included were using spectacle correction before CXL took place. Overall, there was an observed stability of median corneal curvature at follow-up, suggesting no disease progression.One prior study included nine case series, reporting that safety and visual outcomes of contact lens-assisted CXL for thin corneas was comparable to conventional CXL in adults. This, along with other studies centered around adults, provide some evidence guiding practitioners in treatment of thin keratoconic corneas in adults, but there is much less evidence in treatment guiding for kids.In the present study, corneal curvature stability was achieved in a majority of eyes. Of the 21 included eyes, Kmax remained stable in 71.4% with either a change of less than 1.00D (33.3%) or a decrease or flattening of more than 1.00D (38.0%). As well, K2 of 61.9% of eyes had either a change of less than 1.00D (23.8%) or had a median decrease in K2 of more than 1.00D (38.1%).The researchers convey in their paper that “the stabilization of corneal and visual acuity measurements reported in this study provides clinicians with more evidence to formulate treatment strategies for these patients to prevent the visual deterioration associated with keratoconus progression.” However, they do caution that “clinicians should be aware of the significant risks of adverse events that may occur with CXL in this patient group.”Click here for the journal source. Proxenos CJ, Kandel H, Gupta A, et al. Corneal crosslinking for keratoconus in children with thin corneas: a multicentre registry study. AJO Int. June 10, 2025. [Epub ahead of print].