Does pregnancy cause progression of keratoconus in previously cross-linked corneas?
Reviewed by Mahmoud Ahmed

This is a prospective study involving 24 eyes of 19 patients with stabilised or regressed keratoconus after a successful accelerated cross linking (A-CXL) treatment. Patients were recruited at a routine follow-up visit in the first month of their pregnancy. The mean time between CXL and conception was 12.4 ±5.1 months. The mean postpartum follow-up period was 27.6 ±13.3 months. The mean age was 25.8 ±4.8 years. The mean corrected distance visual acuity (CDVA) and the mean manifest astigmatism (MA) remained stable during and after pregnancy (P > 0.05 for all variables). The mean Kmax increased significantly during pregnancy (P = 0.037, after CXL versus pregnancy), and again flattened significantly after pregnancy (P = 0.035, pregnancy versus after pregnancy). The mean K1 and K2 readings remained stable during pregnancy (P > 0.05, after CXL versus pregnancy). Surprisingly, they decreased significantly after pregnancy (P = 0.05 for K1 and P = 0.003 for K2, pregnancy versus after pregnancy). Ten eyes (41.67%) showed progression on topography during pregnancy with worsening Kmax but nine of these eyes regressed significantly to the pre-pregnancy levels again. This study, albeit with a small sample size, suggests the crosslinked corneas return to pre-pregnancy levels once the effects of pregnancy have subsided. This indicates a higher threshold is indeed needed before proceeding with re-treatment in crosslinked eyes of pregnant patients.

Dynamics of keratoconus progression after a previous successful accelerated crosslinking treatment during and after pregnancy.
Sarac O, Yesilirmak N, Caglayan M, et al.
JOURNAL OF CATARACT AND REFRACTIVE SURGERY
2022;48(5):599-603.