Related Experiment Video
Updated: Sep 22, 2025
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Three-year follow-up of accelerated versus standard corneal cross-linking in paediatric Keratoconus
Adi Einan-Lifshitz1,2, Asaf Achiron3, Shira Hed4
1Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. adi.einan@gmail.com.
Insights
Accelerated corneal cross-linking (A-CXL) is effective for pediatric keratoconus, showing results comparable to standard CXL (S-CXL). Both treatments improved visual acuity and reduced corneal steepness over three years.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Keratoconus (KC) is a progressive corneal condition affecting children.
- Standard corneal collagen cross-linking (S-CXL) effectively halts KC progression.
- Long-term efficacy of accelerated CXL (A-CXL) in pediatric KC is less understood.
Purpose of the Study:
- To compare the long-term efficacy of A-CXL versus S-CXL in pediatric KC patients.
- To evaluate visual acuity, refractive errors, and keratometric changes over three years post-treatment.
Main Methods:
- Historical cohort analysis of 93 pediatric KC eyes (≤18 years) from 2010-2017.
- Patients underwent either S-CXL or A-CXL at two tertiary centers.
- Preoperative and 3-year postoperative data included visual acuity (BSCVA, UCVA), refractive error, and keratometry (Kmax, thinnest pachymetry).
Main Results:
- Both S-CXL and A-CXL significantly improved UCVA and BSCVA (p<0.05).
- A-CXL demonstrated non-inferior visual acuity outcomes compared to S-CXL (within ±0.2 LogMAR).
- Kmax and thinnest pachymetry decreased in both groups; A-CXL showed comparable results to S-CXL within non-inferiority margins for pachymetry.
Conclusions:
- A-CXL is a viable, effective treatment for pediatric keratoconus, comparable to S-CXL over three years.
- Both A-CXL and S-CXL improve visual function and reduce corneal steepness in children.
- Further analysis is needed to confirm non-inferiority of A-CXL for Kmax reduction compared to S-CXL.
Purpose:
Standard corneal collagen cross-linking (S-CXL) is an effective treatment to arrest Keratoconus (KC) progression in children. Less is known on the long-term efficacy of accelerated CXL (A-CXL) in paediatric populations.
Methods:
A historical cohort analysis of paediatric patients (≤18 years) with KC who underwent S-CXL and A-CXL at two tertiary referral centres in Israel between 2010-2017. Preoperative and 3-year postoperative evaluation included changes in visual acuity (best spectacle corrected [BSCVA]) and uncorrected [UCVA]), refractive errors, and keratometric data.
Results:
Ninety-three eyes of 93 patients were analysed (A-CXL: n = 39; S-CXL: n = 54). Baseline characteristics were similar between groups. Both groups showed a significant improvement in visual acuity compared to baseline (S-CXL: 0.810-0.602 LogMAR UCVA; A-CXL: 0.890-0.306 LogMAR UCVA, p < 0.05 for both). Improvement in BSCVA and UCVA following A-CXL was non-inferior to S-CXL (< ± 0.2 LogMAR). Kmax decreased by a mean of 0.98 ± 5.56 dioptres following S-CXL (p = 0.02) and by 1.48 ± 8.4 dioptres following A-CXL (p = 0.015). Thinnest pachymetry decreased following both treatments (S-CXL: by 26.8 ± 40.7 µm, p = 0.001, A-CXL: by 10.2 ± 13.4 µm, p = 0.028), the difference between groups was within the non-inferiority margin (< ± 10 µm).
Conclusions:
Paediatric patients followed for three years after A-CXL showed improved visual function, reduced corneal astigmatism and Kmax, and decreased thinnest corneal thickness. A-CXL was non-inferior to S-CXL at three years in terms of best-corrected and uncorrected visual acuity, thinnest pachymetry, and astigmatism. For Kmax, non-inferiority could not be concluded.
More Related Videos
05:56Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model
Published on: April 3, 2016
12:25Second Harmonic Generation Signals in Rabbit Sclera As a Tool for Evaluation of Therapeutic Tissue Cross-linking TXL for Myopia
Published on: January 6, 2018
Related Concept Videos
01:28Angle Closure Glaucoma: Treatment
01:27Open Angle Glaucoma: Treatment
Drugs such as carbonic anhydrase inhibitors, α2- and...