Bilateral simultaneous accelerated corneal collagen cross-linking in pediatric keratoconus: 24-month follow-up results.

Purpose: To study the long-term clinical outcome of the bilateral simultaneous accelerated corneal collagen cross-linking (ACXL) procedure in progressive keratoconus in the pediatric population at 24-month follow-up.

Methods: This is a retrospective cross-sectional study that included 39 patients (78 eyes) with progressive pediatric keratoconus treated with epi-off bilateral ACXL in the same sitting between 2018 and 2022. The change in pre-operative vs. post-operative distance-corrected visual acuity (DCVA), average keratometry, maximum keratometry (Kmax), and thinnest corneal thickness (TCT) values was assessed at the end of 24 months.

Results: A total of 78 eyes of 39 patients with a mean age of 15.2 ± 1.8 years were taken. About 27 (69.2%) were males, and 12 (30.7%) were females. At 24 months, there was a significant improvement in the mean DCVA of 0.256 ± 0.319 (P = 0.00001) and 0.239 ± 0.319 logMAR units (P = 0.00001) for the right (RE) and left eye (LE), respectively. The average keratometry (Avg K) decreased significantly from 48.65 ± 5.63 to 47.82 ± 5.43 D (P = 0.00069) and from 49.76 ± 5.17 to 47.7 ± 4.68 D for RE and LE, respectively. Pre-operative TCT in RE and LE was 445.15 ± 48.49 µm and 444.46 ± 45.81 µm which stabilized post-operatively in RE at 439.51 ± 47.18 µm and in LE at 434.24 ± 48.24 µm (P = 0.00456). No significant side effects (permanent corneal haze, keratitis, or endothelial damage) were observed.

Conclusion: Bilateral simultaneous ACXL is an effective and safe procedure to improve compliance due to a shorter operative time, especially in the pediatric population.