# Corneal crosslinking via the Dresden protocol versus the accelerated approach in pediatric patients - a retrospective comparative study

## TL;DR

This study compares two corneal crosslinking protocols for treating keratoconus in children, finding both effective but one slightly better at stabilizing the condition.

## Contribution

The study evaluates the Dresden and accelerated corneal crosslinking protocols specifically in pediatric keratoconus patients.

## Key findings

- Both protocols halted keratoconus progression in pediatric patients over 12 months.
- The Dresden protocol showed greater reduction in Kmax compared to the accelerated protocol.
- No significant difference in visual acuity improvement was found between the two protocols.

## Abstract

Keratoconus presents certain peculiarities in pediatric patients when
compared with adults. The greatest challenge in children is that the disease
is more severe and faster in progression. In this retrospective study, we
aimed to compare the accelerated and Dresden protocols for corneal
crosslinking in patients aged <18 years who were followed-up for at least
12 months. Methods: A total of 36 eyes from 27 patients were
included in the study. The best corrected and uncorrected visual acuity,
maximal keratometry, corneal thickness, foveal thickness, and endothelial
microscopy findings were evaluated at baseline and during the postoperative
period at one, three, and six months. Thereafter, the patients were
evaluated at one, three, six and twelve months postoperative. Corneal
crosslinking was performed in all patients via the Dresden protocol (n=21
eyes) or the accelerated protocol (n=15 eyes). Data between the two groups
were compared and XY statistical analysis was used.

Both protocols were effective in halting keratoconus progression. No patient
had progression at the 12-month follow-up. A significant reduction in Kmax
and improvement in the corrected distance visual acuity were observed only
in the Dresden protocol group. Although the Dresden protocol was superior to
the accelerated protocol in reducing Kmax (p=0.002), there was no
significant difference in corrected distance visual acuity between the two
groups.

The accelerated protocol is as efficient as the Dresden protocol in
stabilizing keratoconus progression. Although the Dresden protocol was
superior to the accelerated protocol in reducing the Kmax, it did not
produce better clinical results. Thus, the accelerated protocol is an
efficient option. Furthermore, considering the advantages of reduced
surgical time, the accelerated protocol is effective in halting keratoconus
progression in the pediatric age group.