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Updated: Nov 27, 2025
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Corneal collagen cross-linking in pediatric keratoconus with three protocols: a systematic review and meta-analysis
Ali Mahdavi Fard1, Andrew L Reynolds1, John H Lillvis1
1Department of Ophthalmology, Ross Eye Institute, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
Insights
Corneal collagen cross-linking (CXL) effectively stabilizes pediatric keratoconus, improving vision and corneal shape. Both conventional and accelerated CXL methods show positive outcomes for children with this progressive eye condition.
Area of Science:
- Ophthalmology
- Regenerative Medicine
Background:
- Keratoconus is a progressive corneal disease causing vision loss, particularly aggressive in children.
- It is characterized by corneal thinning and irregular astigmatism.
- Current treatments aim to halt disease progression and preserve vision.
Purpose of the Study:
- To systematically review the efficacy of corneal collagen cross-linking (CXL) protocols for stabilizing pediatric keratoconus.
- To evaluate visual acuity and keratometric outcomes following CXL in children.
- To compare different CXL techniques in pediatric patients.
Main Methods:
- A systematic review of peer-reviewed publications from 2000-2019 was conducted.
- Studies were searched in PubMed, Google Scholars, Web of Science, and Cochrane's Database.
- Data on visual acuity, keratometry, and patient demographics were extracted and analyzed.
Main Results:
- 28 studies involving 1,300 eyes were reviewed.
- Conventional and accelerated epithelium-off CXL significantly improved visual acuity and keratometric indices.
- Transepithelial CXL did not show significant changes in uncorrected visual acuity.
Conclusions:
- Conventional and accelerated corneal collagen cross-linking (CXL) are effective treatments for pediatric keratoconus.
- CXL offers a viable therapeutic option for stabilizing the cornea in children.
- Further research may explore long-term outcomes and comparative effectiveness of different CXL approaches.
Background:
Keratoconus is a bilateral progressive noninflammatory degenerative disease of the cornea characterized by corneal thinning, irregular astigmatism, and subsequent visual impairment. It has an aggressive course in children. This systematic review evaluates the efficacy of available corneal collagen cross-linking (CXL) protocols for stabilizing the cornea in pediatric patients with keratoconus.
Methods:
We searched all peer-reviewed publications from 2000 to 2019 indexed in PubMed, Google Scholars, Web of Science, and Cochrane's Database for the terms keratoconus and cross-linking. The following data were extracted from eligible studies: study design, type of intervention, number of the eyes and mean age of patients for each study, duration of follow-up period, mean pre- and postoperative uncorrected and corrected visual acuity, keratometric and aberrometric indices, were analyzed with RevMan 5.3 software. Intra-and intergroup post hoc analyses of outcome variables were performed using t tests.
Results:
A total of 28 studies, including 1,300 eyes, were reviewed. In conventional and accelerated epithelium-off techniques, there was a significant improvement in uncorrected and corrected visual acuities. Similarly, the keratometric indices improved significantly after CXL. Uncorrected visual acuity did not alter after CXL using transepithelial method.
Conclusions:
Both conventional and accelerated collagen CXL of the cornea are effective therapeutic options in management of keratoconus in children.
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