Abstract
All corneal cross-linking techniques attenuated disease progression in patients with pediatric keratoconus for at least one year based on a meta-analysis. A standard and accelerated technique led to marked improvement in visual acuity. We determined the efficacy and safety of corneal cross-linking (CXL) in pediatric keratoconus by conducting a systematic review and meta-analysis. The PubMed and Cochrane databases were searched for relevant studies on the effects of standard, transepithelial, and/or accelerated CXL protocols in patients aged 18 years or younger. Standardized mean differences with 95% confidence intervals were calculated to compare the data collected at baseline and 12 months. The primary outcomes were maximum keratometry (Kmax) and uncorrected visual acuity (UCVA), and the secondary outcomes were the thinnest corneal thickness (TCT), best-corrected visual acuity (BCVA), and manifest refraction spherical equivalent or cylindrical refraction. Our search yielded 7913 publications, of which 26 were included in our systematic review and 21 were included in the meta-analysis. Standard CXL significantly improved the Kmax, UCVA, and BCVA, and significantly decreased the TCT. Accelerated CXL significantly improved UCVA and BCVA. In the transepithelial and accelerated-transepithelial CXL methods, each measurable parameter did not change after treatments. All CXL techniques attenuated disease progression in patients with pediatric keratoconus for at least one year. Standard and accelerated CXL led to marked improvement in visual acuity.
Highlights
Keratoconus is a progressive, frequently asymmetric, inflammatory corneal thinning disorder characterized by changes in the structure and organization of corneal collagen [1]
Heterogeneity was observed in the TCXL and accelerated CXL (ACXL) groups (p = 0.05, I2 = 68% and p < 0.00001, I2 = 96%, respectively)
We report a systematic review and meta-analysis of all CXL outcomes from 26 publicatWioensr,epwohritcha siynsctluemdeadtic1,r7e1v8ieewyeasnodf mpeedtaia-tarnicalpyastiiseonftsalwl CithXLproougtrceosmsivese fkreormato2c6opnuubsl.icatiToonso,uwrhkinchowinlecdlugdee, dth1is,7i1s8theyeefsirostf cpoemdiparterihcepnasitvieenrtesvwieiwthapnrdogmreestsai-vaenakleyrsaistoocnonthues.eTffoi-our kcnaocwy laenddgsea,ftehtyisoifs athlleCfiXrLstteccohmnipqrueehseunsseivdetoretvreieawt paendidatmricetkae-raantoalcyosniusso.nThtheemeeftfiac-aancyala- nd sayfseistycoonfdaullcCteXdLbyteMchcnAiqnueneas uetseadl. t[o10t]reinat2p01e7diiantcrliucdkeedra1t3oacrotniculess
Summary
Keratoconus is a progressive, frequently asymmetric, inflammatory corneal thinning disorder characterized by changes in the structure and organization of corneal collagen [1]. This progressive bilateral disease weakens the cornea, resulting in myopia, irregular astigmatism, and central corneal scarring. A young age was found to be associated with more severe forms of keratoconus and faster progression in a systematic review and meta-analysis [4]. Keratoconus progression in pediatric patients aged 18 years and younger was found to be associated with a seven-fold higher risk of requiring corneal grafting [5]. The progression of keratoconus was seen at 1 year after diagnosis in almost all of the children [6]
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