Official ESCRS | European Society of Cataract & Refractive Surgeons
Copenhagen 2016 Registration Programme Exhibitor Information Virtual Exhibition Satellite Meetings Glaucoma Day 2016 Hotel Star Alliance

10 - 14 Sept. 2016, Bella Center, Copenhagen, Denmark

This Meeting has been awarded 27 CME credits


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

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Session Details

Session Title: Cross-Linking

Session Date/Time: Sunday 11/09/2016 | 08:00-09:30

Paper Time: 08:12

Venue: Auditorium A

First Author: : L.McAnena IRELAND

Co Author(s): :    F. Doyle   M. O'Keefe                 

Abstract Details


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.


This study was accepted as a thesis for a Masters of Surgery (MCh) at the Royal College of Surgeons in Ireland (RCSI) which was awarded in November 2015. The clinical authors were based at the Mater Private Hospital, Dublin, Ireland


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. 9 papers were included in the meta-analysis, showing significant improvement in UCVA and BCVA and stable Kmax at one year in the standard protocol group, and stable UCVA, BCVA and KMax at 1 year in the trans-epithelial group. MRSE, CCT and ECD remained stable in both groups.


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.

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