Cross-linking in children with keratoconus: a systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#collagen #cornea #corneal-topography #cross-linking-reagents #humans

Cross-linking in children with keratoconus: a systematic review and meta-analysis

McAnena et al., 2017 | Acta Ophthalmol | Meta Analysis

Citation

McAnena Lisa, Doyle Frank, O'Keefe Michael. Cross-linking in children with keratoconus: a systematic review and meta-analysis. Acta Ophthalmol. 2017-May;95(3):229-239. doi:10.1111/aos.13224

Abstract

Keratoconus can behave more aggressively in pediatric than in adult patients. We systematically reviewed the literature to determine the effectiveness of corneal collagen cross-linking (CXL) in children. For this study, MEDLINE® and Cochrane databases were searched for all studies examining the effects of standard, trans-epithelial or accelerated CXL protocols in patients age 18 years or younger. Primary outcomes were; uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) and secondary outcomes were; best-corrected visual acuity (BCVA), mean refractive spherical equivalent (MRSE), central corneal thickness (CCT) and endothelial cell density (ECD). Standardized mean differences (SMD) and 95% confidence intervals were calculated, comparing baseline values with those at 6, 12 and 24 months. A total of 13 papers, published between May 2011 and December 2014 examining 490 eyes of 401 patients with a mean age of 15.25 (±1.5) years, were included in the qualitative analysis in this review. Nine papers were included in the meta-analysis, showing significant improvement in UCVA and BCVA and stable Kmax at 12 months, and stable UCVA, improved BCVA and improved Kmax at 24 months in the standard protocol group UCVA, BCVA and KMax were stable at 12 months in the trans-epithelial group. Mean refractive spherical equivalent (MRSE), CCT and ECD remained stable in both groups. In conclusion it was found that standard CXL may be effective in halting progression of keratoconus in pediatric patients at 1 year. However, larger, more long-term studies are required to ascertain its effectiveness.

Key Findings

However, larger, more long-term studies are required to ascertain its effectiveness.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population adult patients
Sample Size 401
Age Range mean age of 15.25
Condition See abstract

MeSH Terms

  • Collagen
  • Cornea
  • Corneal Topography
  • Cross-Linking Reagents
  • Humans
  • Keratoconus
  • Photochemotherapy
  • Photosensitizing Agents
  • Ultraviolet Rays

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: collagen

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09