OJOph  Vol.4 No.3 , August 2014
Corneal Cross Linking with Riboflavin for Progressive Keratoconus in Paediatric Eyes

Purpose: To report visual, refractive and topographic outcomes after corneal collagen crosslinking (CXL) for progressive keratoconus in paediatric eyes. Methods: In this prospective interventional study, twenty eyes of eighteen patients with progressive keratoconus were included. All eyes underwent CXL with riboflavin after documented progression of the disease. Informed, written consent was taken from the parents of the patients. The patients were followed up for 6 months. Complete ophthalmic examination and Scheimpflug imaging were performed at each visit. Reduction of the mean refractive cylinder, and corneal flattening were the main outcome measures. Results: The mean age of the patients was 13.55 years, (range: 9 - 16 yrs). The mean refractive cylinder reduced from a preoperative value of -5.26D to -4.66D (p = 0.10), -4.31D (p = 0.009), and, -4.10D (p = 0.003) at one, three and six months (postoperative) respectively. The mean average K value increased from 51.88D to 52.18D (p = 0.64) at one month postoperatively and reduced thereafter to 51.28D (p = 0.32) and 51.54D (p = 0.02) at three and six months respectively. Thinnest pachymetry reduced very significantly from a mean preoperative value of 459.15 μm to 400.8 μm (p < 0.001), 405.9 μm (p < 0.001) and 413.6 μm (p < 0.001) postoperatively at one, three and six months respectively. Best corrected visual acuity (decimal units) improved insignificantly from a preoperative value of 0.43 to 0.49 (p = 0.42) at six months postoperatively. Conclusion: Short term results of corneal collagen crosslinking with riboflavin for progressive keratoconus in children are promising in terms of reduction in the mean refractive cylinder and flattening of the cornea, and appears effective in halting the progression of the disease in the paediatric age group. Long term follow up is required to assess the lasting effect of CXL in this age group.

Cite this paper
Nawani, N. , Jain, A. and Singh, C. (2014) Corneal Cross Linking with Riboflavin for Progressive Keratoconus in Paediatric Eyes. Open Journal of Ophthalmology, 4, 90-99. doi: 10.4236/ojoph.2014.43015.
[1]   Tuori, A.J., Virtanen, I., Aine, E., et al. (1997) The Immunohistochemical Composition of Corneal Basement Membrane in Keratoconus. Current Eye Research, 16, 792-801.

[2]   Cheng, E.L., Maruyama, I., SundarRaj, N., et al. (2001) Expression of Type XII Collagen and Hemidesmosome-Associated Proteins in Keratoconus Corneas. Current Eye Research, 22, 333-340.

[3]   Radner, W., Zehetmayer, M., Skorpik, Ch. and Mallinger, R. (1998) Altered Organization of Collagen in Apex of Keratoconus Corneas. Ophthalmic Research, 30, 327-332.

[4]   Rabinowitz, Y.S. (1998) Keratoconus. Survey of Ophthalmology, 42, 297-319.

[5]   Funderburgh, J.L., Panjwani, N., Conrad, G.W. and Baum, J. (1989) Altered Keratan Sulfate Epitopes in Keratoconus. Investigative Ophthalmology Visual Science, 30, 2278-2281.

[6]   Rehany, U., Lahav, M. and Shoshan, S. (1982) Collagenolytic Activity in Keratoconus. Annals of Ophthalmology, 14, 751-754.

[7]   Sawaguchi, S., Yue, B.Y.J.T., Chang, I., et al. (1991) Proteoglycan Molecules in Keratoconus Corneas. Investigative Ophthalmology Visual Science, 32, 1846-1853.

[8]   Wollensak, J. and Buddecke, E. (1990) Biochemical Studies on Human Corneal Proteoglycans—A Comparison of Normal and Keratoconic Eyes. Graefe’s Archive for Clinical and Experimental Ophthalmology, 228, 517-523.

[9]   Kao, W.W.-Y., Vergnes, J.-P., Ebert, J., et al. (1982) Increased Collagenase and Gelatinase Activities in Keratoconus. Biochemical and Biophysical Research Communications, 107, 929-936.

[10]   Sawaguchi, S., Yue, B.Y.J.T., Sugar, J. and Gilboy, J. (1989) Lysosomal Enzyme Abnormalities in Keratoconus. Archives of Ophthalmology, 107, 1507-1510.

[11]   Zhou, L., Sawaguchi, S., Twining, S.S., Sugar, J., Feder, R.S. and Yue, B.Y. (1998) Expression of Degradative Enzymes and Protease Inhibitors in Corneas with Keratoconus. Investigative Ophthalmology & Visual Science, 39, 1117-1124.

[12]   Kenney, M.C., Nesburn, A.B., Burgeson, R.E., Butkowski, R.J. and Ljubimov, A.V. (1997) Abnormalities of the Extracellular Matrix in Keratoconus Corneas. Cornea, 16, 345-351.

[13]   Daxer, A. and Fratzl, P. (1997) Collagen Fibril Orientation in the Human Corneal Stroma and Its Implication in Keratoconus. Investigative Ophthalmology & Visual Science, 38, 121-129.

[14]   Reeves, S.W., Stinnett, S., Adelman, R.A. and Afshari, N.A. (2005) Risk Factors for Progression to Penetrating Keratoplasty in Patients with Keratoconus. American Journal of Ophthalmology, 140, 607.e1-607.e6.

[15]   Wollensak, G. (2006) Crosslinking Treatment of Progressive Keratoconus: New Hope. Current Opinion in Ophthalmology, 17, 356-360.

[16]   Wollensak, G., Spoerl, E. and Seiler, T. (2003) Stress-Strain Measurements of Human and Porcine Corneas after Riboflavin-Ultraviolet-A-Induced Cross-Linking. Journal of Cataract & Refractive Surgery, 29, 1780-1785.

[17]   Caporossi, A., Mazzotta, C., Baiocchi, S. and Caporossi, T. (2010) Long-Term Results of Riboflavin Ultraviolet A Corneal Collagen Cross-Linking for Keratoconus in Italy: The Siena Eye Cross Study. American Journal of Ophthalmology, 149, 585-593.

[18]   Raiskup-Wolf, F., Hoyer, A., Spoerl, E. and Pillunat, L.E. (2008) Collagen Crosslinking with Riboflavin and Ultraviolet-A in Keratoconus: Long-Term Results. Journal of Cataract & Refractive Surgery, 34, 796-801.

[19]   Caporossi, A., Mazzotta, C., Baiocchi, S., Caporossi, T., Denaro, R. and Balestrazzi, A. (2012) Riboflavin-UVA-Induced Corneal Collagen Cross-Linking in Pediatric Patients. Cornea, 31, 227-231.

[20]   Wollensak, G., Spoerl, E. and Seiler, T. (2003) Riboflavin/Ultraviolet-A-Induced Collagen Crosslinking for Treatment of Keratoconus. American Journal of Ophthalmology, 135, 620-627.

[21]   Vinciguerra, P., Albe, E., Trazza, S., Rosetta, P., Vinciguerra, R., Seiler, T. and Epstein, D. (2009) Refractive, Topographic, Tomographic, and Aberrometric Analysis of Keratoconic Eyes Undergoing Corneal Cross-Linking. Ophthalmology, 116, 369-378.

[22]   Hersh, P.S., Greenstein, S.A. and Fry, K.L. (2011) Corneal Collagen Crosslinking for Keratoconus and Corneal Ectasia: One-Year Results. Journal of Cataract & Refractive Surgery, 37, 149-160.

[23]   Mazzotta, C., Traversi, C., Baiocchi, S., Caporossi, O., Bovone, C., Sparano, M.C., Balestrazzi, A. and Caporossi, A. (2008) Corneal Healing after Riboflavin Ultraviolet-A Collagen Cross-Linking Determined by Confocal Laser Scanning Microscopy in Vivo: Early and Late Modifications. American Journal of Ophthalmology, 146, 527-533.

[24]   Mazzotta, C., Balestrazzi, A., Traversi, C., Baiocchi, S., Caporossi, T., Tommasi, C. and Caporossi, A. (2007) Treatment of Progressive Keratoconus by Riboflavin-UVA-Induced Cross-Linking of Corneal Collagen: Ultrastructural Analysis by Heidelberg Retinal Tomograph II in Vivo Confocal Microscopy in Humans. Cornea, 26, 390-397.