Keratoconus can behave more aggressively in paediatric than in adult patients. Collagen cross-linking has been shown to slow the progression of keratoconus in adults. This systematic review determined the effectiveness of corneal collagen cross-linking (CXL) in children. For this study, MEDLINE and Cochrane databases were searched for all studies examining the effects of standard, trans-epithelial or accelerated CXL protocols in patients age 18 years or younger. The primary outcomes were uncorrected visual acuity (UCVA) and maximum keratometry (Kmax). Secondary outcomes were; best-corrected visual acuity (BCVA), mean refractive spherical equivalent (MRSE), central corneal thickness (CCT) and endothelial cell density (ECD). The standardised mean differences (SMD) and 95% confidence intervals were calculated, comparing baseline values with those at six, 12 and 24 months. A total of 13 papers, published between May 2011 and December 2014 examining 490 eyes of 401 patients with a mean age of 15.25 (SD1.5) years, were included in the qualitative analysis in this review. Nine papers were included in the meta-analysis, showing significant improvement in UCVA and BCVA and stable Kmax at 12 months, and stable UCVA, improved BCVA and improved Kmax at 24 months in the standard protocol group UCVA, BCVA and KMax were stable at 12 months in the trans-epithelial group. MRSE, CCT and ECD remained stable in both groups. This systematic review found that standard CXL may be effective in halting progression of keratoconus in paediatric patients at one year. However, larger, long-term studies are required to ascertain its effectiveness, as well as to follow-up for any long-term complication, in particular endothelial decompensation.

Cross-linking in children with keratoconus: a systematic review and meta-analysis.
McAnena L, Doyle F, O’Keefe M.
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Eulee Seow

University Hospital of Wales, UK.

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