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Progression of Paediatric Keratoconus Following Corneal Cross-Linking: A Systematic Review and Pooled Analysis

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First Author: A.Abraham UK

Co Author(s):    A. Achiron   D. Tole   V. Avadhanam   K. Darcy   O. El-Haddad        

Abstract Details

Purpose:

Corneal collagen cross linking (CXL) is an effective treatment to arrest Keratoconus (KC) progression in adults. Several studies have also shown effectiveness of CXL in pediatric populations, yet no systematic analysis has been performed and no accepted definition for progression is available in children after CXL. The aim of this study is to establish the most commonly used criteria for progression and perform a systematic review of the literature with pooled analysis to assess the progression of keratoconus in children after CXL.

Setting:

A systemic literature review combined with pooled statistical analysis was performed on all English language studies published up to May 2020.

Methods:

Studies detailing the progression of KC after CXL treatment in a paediatric population were included, and the methods used to report progression of KC were analysed. The most commonly employed progression method identified was used to perform meta-analysis on the pooled results.

Results:

33 studies (1841 eyes) were identified on rates of KC progression after CXL. The most common method to report progression was an increase in Kmax, Kmean, or Ksteep by ≥1.0 diopter (75.7% of studies). Using this criteria the mean pooled progression rate following epithelium-off CXL was 10.6% (95% CI: 6.2%-15.9%, total pooled sample size: 1271 eyes) with high heterogeneity between studies (I2=86.45% (95% confidence interval:80.24 - 90.71), p< 0.0001).

Conclusions:

When defining KC progression following CXL in children based on increase in Kmax, Kmean or Ksteep ≥1.0 diopter, the risk of progression was 10.6% in our analysis of published studies. We encourage clear quantitative reporting of KC progression in future studies evaluating CXL efficacy in paediatric populations.

Financial Disclosure:

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