Related Experiment Video
Updated: Jun 12, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Comparative effectiveness of accelerated and standard corneal cross-linking in pediatrics: a systematic review and
Yousef Mesaed Al-Shammari1, Faisal Aljassar2, Shaikhah Mesaed Al-Shammari3
1Department of Ophthalmology, Albahar Eye Center, Ibn Sena Hospital, Kuwait City, Kuwait. yousef.alnabahan@gmail.com.
Insights
Accelerated corneal collagen cross-linking (CXL) shows outcomes equivalent to standard CXL in pediatric keratoconus patients. This faster procedure offers a viable alternative, though long-term safety needs further study.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Pediatric keratoconus is a progressive corneal thinning disorder.
- Standard corneal collagen cross-linking (CXL) is a common treatment to halt progression.
- Accelerated CXL offers a potentially faster treatment protocol.
Purpose of the Study:
- To compare the efficacy and safety of accelerated versus standard epithelium-off CXL in pediatric keratoconus.
- To evaluate visual acuity and topographic outcomes between the two CXL methods.
Main Methods:
- Systematic literature search of PubMed, Scopus, Embase, and Web of Science.
- Included studies compared accelerated (9 mW/cm² × 10 min or 18 mW/cm² × 5 min) with standard (3 mW/cm² × 30 min) epithelium-off CXL in patients <18 years.
- Primary outcomes included spherical equivalent, UCVA, BCVA, and K-max; data pooled using random-effects model.
Main Results:
- Eight studies with 571 eyes (464 patients) were analyzed.
- No significant differences were found in spherical equivalent, UCVA, BCVA, or K-max between accelerated and standard CXL.
- Low heterogeneity for visual and SE outcomes; high heterogeneity for K-max.
Conclusions:
- Accelerated CXL demonstrates comparable visual and topographic results to standard CXL in pediatric keratoconus.
- The shorter procedure time makes accelerated CXL a feasible short- to mid-term option for selected pediatric patients.
- Long-term safety and durability of accelerated CXL require further investigation.
Purpose:
We aim to evaluate the efficacy and safety of accelerated corneal collagen cross-linking (CXL) compared with standard CXL in pediatric keratoconus.
Methods:
We conducted comprehensive search of PubMed, Scopus, Embase and Web of Science until September 2025. Studies comparing accelerated (9 mW/cm² × 10 min or 18 mW/cm² × 5 min) with standard (3 mW/cm² × 30 min) epithelium-off CXL in patients < 18 years were included. Primary outcomes were spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and maximum keratometry (K-max). Data was pooled using a random-effects model and risk of bias was assessed with ROB-2 and NOS.
Results:
Eight studies were included involving 571 eyes and 464 patients. No significant differences were found between accelerated and standard CXL in mean SE (MD = - 0.02, P = 0.84), UCVA (MD = - 0.06, P = 0.08) BCVA (MD = - 0.02, P = 0.47) or K-max (MD = 0.28, P = 0.72). Heterogeneity was low for SE, UCVA and BCVA but high for K-max. Sensitivity analyses confirmed robustness of results.
Conclusions:
Accelerated CXL provides visual and topographic outcomes equivalent to standard CXL while offering significantly shorter procedure times. These findings suggest that accelerated epithelium-off CXL may be a feasible short- to mid-term alternative in selected pediatric patients, but long-term safety and durability require further confirmation.
