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Corneal Cross-linking in Pediatric Populations: Systematic Review and Future Perspectives
Claudia R Morgado1, Nicole B Larivoir1, Juliana F Santos1
1From the Department of Ophthalmology at University of São Paulo, São Paulo, Brazil.
Insights
Corneal cross-linking (CXL) effectively stabilizes keratoconus in patients under 18. Both standard and accelerated CXL protocols show high success rates, offering a safe treatment for pediatric keratoconus.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Keratoconus is a progressive corneal ectasia affecting younger individuals.
- Effective treatment is crucial to prevent vision loss in pediatric patients.
- Corneal cross-linking (CXL) aims to halt keratoconus progression.
Purpose of the Study:
- To evaluate the efficacy of standard and accelerated corneal cross-linking (CXL) protocols.
- To analyze stabilization outcomes in patients diagnosed with keratoconus and younger than 18 years.
- To compare different CXL approaches in the pediatric population.
Main Methods:
- Systematic review adhering to PRISMA 2020 guidelines.
- Comprehensive literature search of PubMed and Scopus databases (December 2024).
- Analysis of maximum keratometry measurements (preoperative vs. postoperative) from 35 eligible studies.
Main Results:
- Included 2,186 eyes across 35 studies (15 standard CXL, 11 accelerated CXL, 9 comparative).
- Observed stabilization rates exceeding 80% across various CXL protocols.
- Younger age, keratoconus severity, and cone eccentricity influenced treatment effectiveness.
Conclusions:
- Standard and accelerated CXL are safe and effective for pediatric keratoconus.
- CXL provides a viable therapeutic option for stabilizing corneal ectasia in children.
- Further research may refine patient selection based on influencing factors.
Purpose:
To analyze stabilization results using various standard and accelerated corneal cross-linking (CXL) protocols in patients younger than 18 years.
Methods:
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. A bibliographic search was carried out based on PubMed and Scopus data, with the last being performed in December 2024. Thirty-five articles were eligible for this review. To assess the effectiveness of CXL in children, maximum keratometry measurements were analyzed preoperatively and compared with postoperative values.
Results:
A total of 2,186 eyes were included in this review. This review consisted of 15 studies with the standard CXL protocol, 11 with the accelerated CXL protocol, and 9 comparative protocols. Standard and accelerated CXL protocols and comparative studies were analyzed separately. Most studies have shown stabilization rates greater than 80% with different CXL protocols. Factors such as younger age, severity of keratoconus, and cone eccentricity seem to influence the effectiveness of the procedure.
Conclusions:
The results indicate that standard and accelerated CXL are effective and safe therapeutic options for treating keratoconus in pediatric population.
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