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Updated: Apr 22, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Accelerated corneal collagen cross-linking in pediatric patients: two-year follow-up results
Rohit Shetty1, Harsha Nagaraja1, Chaitra Jayadev1
1Narayana Nethralaya Eye Hospital, 121/C Chord Road, 1 "R" Block, Rajajinagar, Bangalore, Karnataka 560 010, India.
Insights
Accelerated corneal collagen cross-linking (ACXL) is safe and effective for pediatric keratoconus patients under 14. Treatment improved visual acuity and reduced astigmatism, though vernal keratoconjunctivitis requires careful management.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Keratoconus is a progressive corneal ectasia affecting young individuals.
- Early intervention is crucial to prevent vision loss in pediatric keratoconus.
- Accelerated corneal collagen cross-linking (ACXL) offers a less time-intensive treatment option.
Purpose of the Study:
- To assess the efficacy and safety of ACXL in patients younger than 14 years with progressive keratoconus.
- To evaluate visual acuity, refractive error, and corneal topography changes post-ACXL.
- To identify potential risk factors for progression in this pediatric cohort.
Main Methods:
- A prospective study involving 18 patients (30 eyes) with progressive keratoconus.
- Preoperative and 24-month postoperative assessments included visual acuity, topography, and specular microscopy.
- ACXL procedure was performed on all participants.
Main Results:
- Significant improvements were observed in uncorrected and corrected distant visual acuity (P=0.005 and P<0.001, respectively).
- Mean cylinder power decreased significantly (P=0.008), indicating a reduction in astigmatism.
- No intra- or postoperative complications were reported; however, three eyes with vernal keratoconjunctivitis showed progression.
Conclusions:
- ACXL is a safe and effective treatment for pediatric keratoconus.
- Close monitoring and optimal management of co-existing vernal keratoconjunctivitis are essential for successful outcomes.
Purpose:
To evaluate the effectiveness and safety of accelerated corneal collagen cross-linking (ACXL) in patients below 14 years of age with progressive keratoconus.
Materials And Methods:
Thirty eyes of 18 patients with established progressive keratoconus underwent preoperative and postoperative visual acuity assessment, topography, and specular microscopy prior to ACXL and were followed up for 24 months.
Results:
Mean age of the patients was 12.7 years with ten males and eight females. There was an improvement in the mean postoperative uncorrected distant visual acuity (from 0.76±0.26 to 0.61±0.25; P=0.005), mean corrected distant visual acuity (from 0.24±0.19 to 0.12±0.12; P<0.001), mean spherical refraction (from -3.04 DS±3.60 to -2.38 DS±3.37; P=0.28), mean cylinder (from -3.63 DC±1.82 to -2.80 DC±1.48; P=0.008), and spherical equivalent (from -4.70 D±3.86 to -3.75 D±3.49; P=0.15). Three eyes of two patients with vernal keratoconjunctivitis (VKC) showed progression. There were no intra- or postoperative complications.
Conclusion:
In pediatric patients ACXL is an effective and safe procedure for the management of keratoconus. Optimal management of VKC is important to arrest the progression of keratoconus.
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