International Journal of Keratoconus and Ectatic Corneal Diseases

Register      Login

VOLUME 3 , ISSUE 2 ( May-August, 2014 ) > List of Articles


Corneal Cross-linking in Patients Younger than 18 Years: Long-term Follow-up in Three Israeli Medical Centers

David Zadok, Isaac Avni, Erez Bakshi, Irina S Barequet, Isaac Aizenman, Samuel Levinger

Citation Information : Zadok D, Avni I, Bakshi E, Barequet IS, Aizenman I, Levinger S. Corneal Cross-linking in Patients Younger than 18 Years: Long-term Follow-up in Three Israeli Medical Centers. Int J Kerat Ect Cor Dis 2014; 3 (2):84-87.

DOI: 10.5005/jp-journals-10025-1084

Published Online: 01-06-2017

Copyright Statement:  Copyright © 2014; The Author(s).



To report refractive, topographic and safety outcomes of corneal cross-linking (CXL) in patients younger than 18 years of age with progressive keratoconus.

Materials and methods

In this retrospective study, we enrolled 31 eyes of 21 children aged 11 to 17 years that underwent corneal riboflavin-ultraviolet A induced CXL due to progressive keratoconus at three different ophthalmology departments in Israel. They were followed for 3 to 48 months (average 23 ± 13.6 months). Evaluated parameters were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction, pachymetry, slit- lamp examination and corneal topography at baseline and at 1,3,6,12,24 and 48 months.


We found a nonsignificant improvement in UCVA and BSCVA with a small reduction of manifest cylinder and no significant change in spherical equivalent or K-values. Following CXL, stability of UCVA and BSCVA at the last follow-up examination was found in 71 and 77% of treated eyes, respectively. No permanent adverse events have been recorded throughout the study period.


In our series, CXL was a safe procedure in the pediatric population. Stabilization of progressive keratoconus was achieved in visual acuity, refractive and topography parameters with no improvement in corneal indices in contrary to adult CXL treatment.

How to cite this article

Bakshi E, Barequet IS, Aizenman I, Levinger S, Avni I, Zadok D. Corneal Corss-linking in Patients Younger than 18 Years: Long-term Follow-up in Three Israeli Medical Centers. Int J Kerat Ect Cor Dis 2014;3(2):84-87.

PDF Share
  1. Keratoconus. Surv Ophthalmol 1998;42: 297-319.
  2. The immunohistochemical composition of corneal basement membrane in keratoconus. Curr Eye Res 1997;16:792-801.
  3. Expression of type XII collagen and hemidesmosome-associated proteins in keratoconus corneas. Curr Eye Res 2001;22:333-340.
  4. Clinical and corneal biomechanical changes after collagen cross-linking with ribo- flavin and UV irradiation in patients with progressive keratoconus: results after 2 years of follow-up. Cornea 2012 Jun;31(6):609-614.
  5. On-eye performance of custom wavefront-guided soft contact lenses in a habitual soft lens-wearing keratoconic patient. J Refract Surg 2007;23: 960-964.
  6. Intracorneal ring segment implantation for the management of keratoconus: safety and efficacy. J Cataract Refract Surg 2007;33:1886-1891.
  7. Intracorneal ring segments for keratoconus correction: long-term follow-up. J Cataract Refract Surg 2006;32:978-985.
  8. Penetrating keratoplasty for keratoconus. Cornea 1987;6:298-305.
  9. Penetrating keratoplasty for keratoconus: visual outcome and success. Ophthalmology 2000; 107:1125-1131.
  10. Riboflavin/ultraviolet: A induced collagen cross-linking for the treatment of keratoconus. Am J Ophthalmol 2003;135:620-627.
  11. Treatment of keratoconus by collagen cross-linking. Ophthalmology 2003;100:44-49.
  12. Cross-linking treatment of progressive keratoconus: new hope. Curr Opin Ophthalmol 2006;17:356-60.
  13. Stress-strain measurements of human and porcine corneas after riboflavin/ultraviolet- Ainduced collagen cross-linking. J Cataract Refract Surg 2003;29: 1780-1785.
  14. Biomechanical evidence of the distribution of cross-links in corneas treated with riboflavin and ultraviolet A light. J Cataract Refract Surg 2006;32:279-283.
  15. Induction of cross-links in corneal tissue. Exp Eye Res 1998;66:97-103.
  16. Techniques for stiffening the cornea. J Refract Surg 1999;15:711-713.
  17. Increased resistance of cross- linked cornea against enzymatic digestion. Curr Eye Res 2004; 29:35-40.
  18. Enzymatic evidence of the depth dependence of stiffening on riboflavin/UVA treated corneas. Ophthalmology 2008;105:165-169.
  19. Two-year corneal cross-linking results in patients younger than 18 years with documented progressive keratoconus. Am J Ophthalmol 2012;154:520-526.
  20. Corneal corss-linking for progressive keratoconus in children – our experience. International J of Keratoconus and ecstatic corneal diseases 2012; 1:53-56.
  21. Parasurgical therapy for keratoconus by riboflavin-ultraviolet type A induced cross-linking of corneal collagen: preliminary refractive results in an Italian study. J Cataract Refract Surg 2006;32:837-845.
  22. Corneal healing after riboflavin-ultraviolet A cross-linking determined by confocal laser scanning microscopy in vivo: early and late modifications Am J Ophthalmol 2008;146:527-533.
  23. Safety of UVA-riboflavin cross-linking of the corneal. Cornea 2007;26:385-389.
  24. Safety of corneal collagen cross-linking with UV-A and riboflavin in progressive keratoconus. Cornea 2010 Apr;29(4):409-411.
  25. Corneal topography indices after corneal collagen corss-linking for keratoconus and corneal ectasia: One-year results. J Cataract Refract Surg 2011;37:1282-1290.
  26. Long-term results of riboflavin ultraviolet A corneal collagen cross-linking for keratoconus in Italy: the siena eye cross study. Am J Ophthalmol 2010;149:585-593.
  27. Collagen corss-linking with riboflavin and ultraviolet A light in keratoconus: long-term results. J Cataract Refract Surg 2008;34:796-801.
  28. Scalability and severity of keratoconus in children. Am J Ophthalmol 2012; 154:56-62.
  29. Corneal cross-linking for progressive keratoconus in four children. J Pediatr Ophthalmol Strabismus 2011;48:e26-e29.
  30. Corneal collagen cross-linking for progressive keratoconus in pediatric patients: a feasibility study. J Refract Surg 2012;28:793-739.
  31. Results of corneal collagen cross-linking in pediatric patients. J Refract Surg 2012;28: 759-762.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.