ESCRS - FP02.02 - Long-Term Outcomes Of Corneal Collagen Cross-Linking In Pediatric Keratoconus: A Ten-Year Follow-Up Study

Long-Term Outcomes Of Corneal Collagen Cross-Linking In Pediatric Keratoconus: A Ten-Year Follow-Up Study

Published 2026 - 44th Congress of the ESCRS

Reference: FP02.02 | Type: Free paper | DOI: 10.82333/4v7h-qx09

Authors: Dr Denise Wajnsztajn* 1 , Dr Jonathan Citrin 2 , Dr Itay Lavy 1 , A/Prof. Joseph Frucht-Pery 1 , A/Prof. ABRAHAM SOLOMON 1

1Ophthalmology,Hadassah Medical Center - Hebrew University Hospital,Jerusalem,Israel, 2Hadassah Medical Center - Hebrew University Hospital,Jerusalem,Israel

Purpose

To evaluate the ten-year outcomes of Cross-linking (CXL) in pediatric Keratoconus (KC) patients, identifying prognostic factors for treatment success and failure.

Setting

Hadassah Medical Center - Ophthalmology Department.

Methods

A retrospective observational study was conducted at Hadassah Medical Center, including 173 eyes from 126 pediatric KC patients (≤18 years at treatment) who underwent CXL between 2007 and 2018. Data were analyzed for corneal flattening (Delta Kmax) and visual acuity improvement (Delta LogMAR) over a mean follow-up of 66.24 months (range: 12-156 months). Comparisons between accelerated and non-accelerated CXL protocols were performed. Multivariate analysis identified predictive factors for treatment outcomes.

Results

Overall, CXL was effective in stabilizing KC progression, with a mean reduction in Kmax of -0.95D (p<0.001) and LogMAR of -0.042 (p=0.01). Non-accelerated CXL demonstrated superior outcomes, with significantly lower failure rates (11.1% vs. 32.8%, p=0.009). Pre-treatment Kmax was a significant predictor of corneal flattening (p=0.007). Kaplan-Meier survival analysis confirmed a longer-lasting effect with non-accelerated CXL (p<0.001). Failure was associated with lower baseline pachymetry.

Conclusions

CXL provides sustained benefits in pediatric KC patients, with notable superiority of non-accelerated protocols. Higher pre-treatment Kmax correlates with better long-term outcomes, while thinner corneas present a higher risk of treatment failure. These findings emphasize the importance of patient selection and protocol optimization in pediatric CXL management. Further studies are needed to refine treatment strategies and assess long-term visual function stabilization.