Accelerated contact lens-assisted corneal crosslinking and piggyback modification in a pediatric case with advanced keratoconus and thin cornea.

A 14-year-old girl presented with bilateral keratoconus (KC). Maximum keratometry was 63.9 diopters (D) in the right eye and 63.7 D in the left eye. Minimum corneal thickness was 371 μm in the right eye and 370 μm in the left eye. The right eye underwent epithelium-off accelerated corneal crosslinking (CXL) using hypotonic dextran-free 0.1% riboflavin solution and a riboflavin-soaked ultraviolet-barrier-free soft contact lens to increase thickness to more than 400 μm. The same procedure was followed for the left eye 4 months later, when 2 riboflavin-soaked soft contact lenses were applied in piggyback fashion. At 19 months postopertively, in the right eye, visual acuity, maximum keratometry, mean keratometry, and topographical indices were improved. In the left eye, visual acuity, mean keratometry, and central KC index were improved. Accelerated CXL and piggyback modification was a safe and an effective treatment in this pediatric case with KC with thin cornea.