Keratoconus tends to have an especially aggressive course in children, making the need for intervention all the more urgent. The advent of collagen crosslinking (CXL) has clearly ushered in a new era for these patients, but the conventional protocol for the procedure subjects patients to a lengthy process that can be difficult to tolerate, especially in young children. Researchers recently found that both conventional and accelerated CXL techniques are effective therapeutic options in the management of keratoconus in these younger patients. The accelerated protocol reduces total procedure time by using higher doses of UV radiation for a shorter time.

Conducting a search of peer-reviewed publications on keratoconus and CXL, a team identified 28 studies of 1,300 pediatric eyes for analysis.

The investigators found that conventional and accelerated epi-off techniques prompted a significant improvement in uncorrected and corrected visual acuity. Similarly, keratometric indices improved significantly after CXL. Uncorrected visual acuity, however, was not affected by the transepithelial method.

Fard AM, Reynolds AL, Lillvis JH, et al. Corneal collagen cross-linking in pediatric keratoconus with three protocols: a systematic review and meta-analysis. J AAPOS. December 3, 2020. [Epub ahead of print].