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This study demonstrates that CVK is a useful tool in the ocular assessment of patients with Down syndrome. The findings suggest that this patient population have abnormalities of corneal shape even in the absence of clinical evidence of keratoconus. A greater than expected incidence of abnormal topographic changes was observed in the parents of these patients.

Purpose: To compare accelerated corneal crosslinking (CXL) alone, CXL with simultaneous intrastromal corneal ring segments (CXL-ICRS), and CXL with simultaneous topography-guided photorefractive keratectomy (CXL-TG-PRK) in progressive keratoconus, pellucid marginal degeneration (PMD), or laser in situ keratomileusis (LASIK)-induced ectasia. Setting: The Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada. Design: Prospective nonrandomized interventional study. Methods: Visual and topographical outcomes using a comparative analysis adjusting for preoperative maximum keratometry (Kmax) were evaluated 1 year postoperatively. Results: Four hundred fifty-two eyes from 375 patients with progressive keratoconus, PMD, or LASIK-induced ectasia that underwent accelerated (9 mW/cm2, 10 minutes) CXL alone (n = 204), CXL-ICRS (n = 126), or CXL-TG-PRK (n = 122) were included. Change in logarithm of the minimum angle of resolution uncorrected distance visual acuity was significant with CXL-ICRS (−0.31; 95% CI, −0.38 to −0.24) and CXL-TG-PRK (−0.16; 95% CI, −0.24 to −0.09), but not with CXL alone. No significant differences in change were found between the 3 groups. Change in corrected distance visual acuity (CDVA) was significant in all 3 groups: −0.12 (95% CI, −0.15 to −0.10) with CXL alone, −0.23 (95% CI, −0.27 to −0.20) with CXL-ICRS, and −0.17 (95% CI, −0.21 to −0.13) with CXL-TG-PRK. Improvement in CDVA was greater with CXL-ICRS than with CXL alone (−0.08 ± 0.02; P < .0001) and CXL-TG-PRK (−0.05 ± 0.02; P = .005). Change in Kmax was significant with CXL-ICRS [−3.21 diopters (D); 95% CI, −3.98 to −2.45] and CXL-TG-PRK (−3.69 D; 95% CI, −4.49 to −2.90), but not with CXL alone (−0.05 D; 95% CI, −0.66 to 0.55). Conclusions: CXL alone might be best for keratoconic patients who meet the inclusion criteria. CXL-ICRS might be more effective for eyes with more irregular astigmatism and worse CDVA and CXL-TG-PRK for eyes requiring improvements in irregular astigmatism but still have good CDVA.