An Update on the Safety and Efficacy of Corneal Collagen Cross-Linking in Pediatric Keratoconus

Keratoconus is a degenerative disease that affects adolescents and young adults and presents with variable thinning and conical deformation of the corneal apex. The resultant irregular astigmatism can progress to levels that can significantly affect everyday activities and overall quality of life. Therefore, stopping the progression of the disease is an essential part in managing patients with keratoconus. Corneal collagen cross-linking is a minimally invasive procedure that stiffens the anterior corneal stroma by creating strong covalent bonds between collagen fibrils. Over the past decade, many studies have proved its safety and efficacy in halting keratoconus progression in adults. This review of the literature highlights the growing trend towards using this treatment in pediatric keratoconic patients. In children, keratoconus tends to be more severe and fast progression is often encountered requiring closer follow-up intervals. Standard cross-linking shows comparable results in children with a good safety-efficacy profile during follow-up periods of up to three years. Further research is needed to standardize and evaluate transepithelial and accelerated cross-linking protocols as these could be of tremendous help in a population where cooperation and compliance are major issues.