While both accelerated transepithelial (epi-on) corneal collagen crosslinking (CXL) and standard CXL (epi-off) halted the progression of keratoconus in children, epi-off CXL was safer and more effective, a recent study reported.

This prospective cohort study included 78 eyes (32 had accelerated epi-on and 46 had epi-off) of patients aged 18 years old or younger with progressive keratoconus. A team evaluated visual acuity, refraction and Scheimpflug imaging parameters preoperatively and postoperatively at one and five years.

The researchers observed an improvement in best-corrected visual acuity to 0.06logMAR and 0.09logMAR in the accelerated epi-on and epi-off groups, respectively. They noted that the mean keratometry value flattened by 0.09D and 3.18D in the accelerated epi-on and epi-off groups at the five-year follow-up, respectively.

The investigators found significant differences at one and five years between the groups for cylinder reduction, flat and mean keratometry and pachymetry. They added that the keratoconus progression rate was 9.37% (3/32) in the accelerated epi-on group and that no progression was seen in the epi-off group at the five-year follow-up.

Henriquez MA, Hernandez-Sahagun G, Camargo J, et al. Accelerated epi-on versus standard epi-off corneal collagen cross-linking for progressive keratoconus in pediatric patients. Cornea. August 11, 2020. [Epub ahead of print].