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One-Year Clinical Study on Efficacy of Corneal Cross-Linking in Indian Children With Progressive Keratoconus

Kumar Kodavoor, Shreesha MS, DNB; Arsiwala, Altaf Z. DNB; Ramamurthy, Dhandapani MD, DNB

doi: 10.1097/ICO.0000000000000197
Clinical Science

Purpose: The aim of this study was to assess the efficacy of corneal collagen cross-linking (CXL) with riboflavin using ultraviolet-A light in children with progressive keratoconus.

Methods: Thirty-five eyes of 24 children with progressive keratoconus aged between 9 and 16 years were included in this retrospective study. Ocular examination included the best-corrected visual acuity (BCVA), dilated refraction, slit-lamp exam, and corneal topography (Orbscan II) at 6 and 12 months. All children were treated with riboflavin with ultraviolet-A light under topical anesthesia and all completed 1-year follow-up.

Results: The mean age of the children was 13.65 years (range, 9–16 years). Follow-up was for a period of 1 year. The mean of preoperative keratometry (Kmax) was 55.11 ± 5.34 diopters (D), whereas the mean of postoperative Kmax was reduced to 53.87 ± 4.99 D. The mean preoperative pachymetry was 412.31 ± 36.54 μm, which changed to 361.31 ± 58.04 μm postoperatively. At 1 year, improvement in the BCVA was noted in 18 (51.42%) eyes, stabilization in 12 (34.28%), and worsening in 5 (14.28%) eyes. Overall, the BCVA improved by 1 line, which was statistically significant (P = 0.0368) at the end of 1 year. There was a reduction in both cylindrical and spherical equivalent, of which, the latter was not statistically significant (P = 0.77), whereas the former was of weak statistical significance (P = 0.061). No complications were reported.

Conclusions: CXL with riboflavin is an effective procedure for children with progressive keratoconus. The results show stabilization, improvement, or both in keratoconus in terms of BCVA and corneal curvature after CXL in most children.

Cornea Clinic, Eye Foundation and Postgraduate Institute of Ophthalmology, Coimbatore, India.

Reprints: Shreesha Kumar Kodavoor, MS, DNB, The Eye Foundation, Coimbatore- 641002, TamilNadu, India (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received October 29, 2013

Accepted May 29, 2014

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