Corneal Cross-Linking for Paediatric Keratoconus: A Systematic Review and Meta-Analysis

Area of Science:

• Ophthalmology
• Corneal Diseases
• Pediatric Eye Care

Background:

• Pediatric keratoconus is a progressive corneal ectasia affecting young individuals.
• Limited data exists on the long-term efficacy and safety of corneal cross-linking (CXL) in this population.
• Standard, accelerated, and transepithelial CXL are potential treatment modalities.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy and safety of CXL in pediatric keratoconus.
• To compare different CXL protocols (standard, accelerated, transepithelial) in patients aged 18 years or younger.
• To evaluate the impact of CXL on key visual and refractive parameters.

Main Methods:

• Systematic review and meta-analysis of studies from PubMed and Cochrane databases.
• Inclusion of studies on standard, transepithelial, and/or accelerated CXL in pediatric patients.
• Calculation of standardized mean differences to compare baseline and 12-month outcomes.

Main Results:

• All CXL techniques attenuated disease progression for at least one year.
• Standard CXL significantly improved maximum keratometry (Kmax), uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA), while decreasing thinnest corneal thickness (TCT).
• Accelerated CXL significantly improved UCVA and BCVA. Transepithelial CXL showed no significant changes in measured parameters.

Conclusions:

• Corneal cross-linking is effective in stabilizing pediatric keratoconus.
• Standard and accelerated CXL demonstrate significant visual acuity improvements in pediatric patients.
• Further research may be needed to clarify the role of transepithelial CXL in this age group.