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Corneal collagen cross-linking in paediatric patients affected by keratoconus
  1. Karl Anders Knutsson,
  2. Giorgio Paganoni,
  3. Stanislav Matuska,
  4. Oriella Ambrosio,
  5. Giulio Ferrari,
  6. Arianna Zennato,
  7. Michela Caccia,
  8. Paolo Rama
  1. Cornea and Ocular Surface Unit, San Raffaele Scientific Institute, Milan, Italy
  1. Correspondence to Dr Paolo Rama, Cornea and Ocular Surface Unit San Raffaele Scientific Institute Via Olgettina 60 Milan, Italy; rama.paolo{at}


Background/aims To evaluate the effectiveness of corneal collagen cross-linking (CXL) in paediatric patients.

Methods Fifty-two eyes of 43 paediatric patients with progressive keratoconus were enrolled in a prospective cohort study. Corneal CXL was performed using a conventional technique with instillation of 0.1% riboflavin solution containing dextran 20% for 30 min during the soaking phase and during the 30 min ultraviolet A irradiation (3 mW/cm2). Visual outcomes, topographic keratometry, maximum keratometry (K-max), refractive astigmatism, demarcation line and endothelial cell density were measured postoperatively.

Results A significant decrease of K-max from 59.30±7.08 to 57.07±6.46 (p<0.001) was observed 2 years after treatment. Uncorrected visual acuity improved from 0.59±0.41 LogMAR (logarithm of the minimum angle resolution) to 0.46±0.33 LogMAR (p=0.06) 2 years after the procedure, while best spectacle corrected visual acuity improved from 0.17±0.11 LogMAR to 0.15±0.12 LogMAR (p=0.17). Twenty-five eyes had K-max values of 60 dioptres (D) or greater. In this subgroup, K-max significantly decreased from 64.94±4.99 D to 62.25±4.42 D at 2 years (p<0.001). The demarcation line of the CXL treatment had a mean value of 249±74 µm and did not show a significant correlation with K-max flattening (Spearman r=0.019, p=0.899). Endothelial cell density remained stable 2 years after the procedure, changing from 2800±363 to 2736±659 cells/mm2 (p=0.90).

Conclusion CXL is an effective treatment for avoiding keratoconus progression in paediatric patients. The procedure is safe and successful in stabilising keratoconus in eyes with more advanced forms of the disease, characterised by topographic K-max values greater than 60 D.

  • Corneal collagen cross-linking
  • keratoconus
  • pediatric keratoconus
  • cross-linking
  • corneal ectasia

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  • Contributors All authors have contributed significantly to the manuscript in accordance to ICMJE 2013 recommendations. All authors respect the following four criteria: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND. Drafting the work or revising it critically for important intellectual content; AND. Final approval of the version to be published; AND. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Regional ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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