Investigation of Epithelial Remodeling After Accelerated Epi-Off Cross-linking in Pediatric Keratoconus

To determine the factors that may affect pediatric epithelial remodeling after accelerated epi-off cross-linking (A-CXL) by examining the changes in epithelial thickness (ET) maps in pediatric keratoconus patients at the 1-year follow-up. Seventy-one eyes of 53 patients (mean age 14.89±1.89 years) were included. Before A-CXL, the MS-39 anterior segment optical coherence tomography images were examined 3, 6, and 12 months after corneal cross-linking (CXL). Significant flattening was observed in Kmax and Ksteep values at 6 and 12 months after A-CXL (P<0.05). No significant change was noted in mean ET, except for the 6 to 8 mm inferonasal area (P>0.05). When max-min ET differences were examined in each region of the corneal ET map, significant improvement was detected in the central 6 mm area, in the 2 to 4 mm inferior-temporal (IT) zone, and in the 4 to 6 mm area in the IT and inferior (I) zones (P<0.05). The change in max-min ET differences in the central 6 mm area before A-CXL and at 12 months after CXL was significantly correlated with the change in corrected distance visual acuity values, corneal keratometry, corneal astigmatism, and stromal thickness parameters (P<0.05). A-CXL is an effective treatment for preventing the progression of pediatric keratoconus and for normalizing ET changes by promoting epithelial remodeling. Epithelial remodeling may have an impact on the improvement in visual acuity after A-CXL by providing a smooth optical surface.