Clinical Outcomes Of Accelerated Cross Linking (A-Cxl) And Accelerated Contact Lens Assisted Cross Linking( A- Cacxl) For Progressive Keratoconus In Paediatric African Population- 3 Year Prospective Study.

Pediatric keratoconus is often more aggressive than in adults, leading to rapid ectatic progression if untreated. Corneal collagen cross-linking (CXL) has emerged as a standard intervention to halt disease progression; however, evidence in African pediatric populations—where distinct genetic, environmental, and healthcare access factors may influence disease behavior—is limited. The purpose of this study is to evaluate the safety ,efficacy and long term outcomes of Accelerated corneal cross-linking (A-CXL) and Accelerated contact lens–assisted corneal cross-linking (A-CACXL) in children and adolescents with progressive keratoconus in an African cohort, where advanced disease and thin corneas are frequently encountered.

This study was conducted at Lions SightFirst Eye Hospital, a tertiary ophthalmic referral center in Nairobi, Kenya. All procedures were performed by a single experienced corneal surgeon to ensure surgical consistency and standardized treatment protocols.In this retrospective study, 187 eyes of 162  patients with progressive  KC were enrolled that visited the Hospital from 2022-2025. Inclusion criteria were a  children < 18 years age and documented progression of KC .

This study includes eyes of 162 children with progressive keratoconus treated between Jan 2022- Dec 2025. Eyes with minimum stromal thickness ≥400 µm underwent epithelium-off accelerated A-CXL (9mW/cm² for 10min; total fluence 5.4J/cm²). Eyes with post-epithelial removal stromal thickness <400 µm underwent A-CACXL using a riboflavin-soaked soft contact lens . Patients were assessed preoperatively, and postoperatively after 1 week, 1, 3, 6 and 12 months, and yearly thereafter up to 3 years.

Primary outcome measures were change in maximum keratometry (Kmax), corrected distance VA (CDVA), and uncorrected distance VA (UDVA) ,central corneal thickness (CCT), endothelial cell density (ECD) and intra- or postoperative complication

A total of 187 eyes (162 patients) were included (A-CXL: 149; A-CACXL: 38). UCVA improved in both groups. Steep, mean, and Kmax decreased significantly at 1 year (p<0.001). Kmax flattening at years 2–3 was sustained but not significant. Mean Kmax reduced by 1.3 D (A-CXL) and 1.03 D (A-CACXL), greatest in baseline Kmax >55 D. CDVA improved ≥1 line in 74% and 48%, respectively. No significant endothelial loss occurred. Transient haze (72% vs 65%) resolved by 6 months; permanent haze occurred in 3 and 1 eyes. Thinnest corneal thickness decreased, most at 3 months. Progression was halted in 91% and 85%, respectively.

Accelerated CXL and accelerated contact lens–assisted CXL are safe and effective in halting keratoconus progression in African patients. A-CACXL extends treatment eligibility to thin corneas , a common presentation in this population, without compromising safety. Outcomes from a single-surgeon, high-volume African center demonstrate reproducible and consistent results, supporting wider adoption of tailored CXL protocols in similar resource-constrained settings.