Accelerated 10 Mw/Cm² Transepithelial Iontophoretic Corneal Cross-Linking For Pediatric Progressive Keratoconus: Up To 11-Year Results
Published 2026 - 44th Congress of the ESCRS
Reference: PP16.04 | Type: Free paper | DOI: 10.82333/87b3-6k77
Authors: Dr Mario Troisi* 1 , Dr Salvatore Troisi 1 , Dr Ciro Caruso 2 , A/Prof. Ciro Costagliola 3
1Ophthalmology,Salerno University Hospital,Salerno,Italy, 2Ophthalmology,Pellegrini Hospital,Naples,Italy, 3Ophthalmology,University of Naples Federico II,Naples,Italy
Purpose
To evaluate the long-term efficacy and safety of accelerated transepithelial iontophoretic corneal collagen cross-linking (Accelerated i-CXL-TE) in pediatric and young adult patients with progressive keratoconus (pKC), reporting outcomes up to 11 years of follow-up.
Setting
This study was conducted at the Cornea Unit of Salerno University Hospital, Salerno, Italy.
Methods
This retrospective longitudinal study included 69 eyes of 56 patients (12–32 years) with documented progressive keratoconus (≥1.5 D increase in Kmax, ≥20 µm thinning, or ≥0.75 D increase in cylinder within 6 months) treated between November 2014 and June 2015. The protocol included epi-on iontophoresis with 0.1% hypotonic riboflavin for 5 minutes followed by accelerated UV-A irradiation (370 nm, 10 mW/cm²) for 9 minutes (5.4 J/cm²). Follow-up was performed at 1, 3, 6, and 12 months, then every 6 months up to 11 years, assessing Kmax, pachymetry, CDVA, endothelial count, IOP, and OCT.
Results
Over a mean follow-up of 9.6 ± 1.8 years (up to 11 years), Kmax showed a sustained reduction, reaching −1.48 ± 0.85 D at last follow-up (p<0.001), with significance from month 6 onward. Overall, 84% of eyes demonstrated stabilization or flattening, and 62% achieved ≥1.0 D reduction. CDVA improved or remained stable in 89.8% (mean gain +0.11 ± 0.09 logMAR, p=0.003). Pachymetry, endothelial cell density (<2% loss), and IOP remained stable (p>0.05). Retreatment was required in 4 eyes (5.8%), with subsequent stabilization. No significant complications were observed.
Conclusions
Accelerated i-CXL-TE demonstrated sustained efficacy in halting progressive keratoconus for up to 11 years in pediatric and young patients, with significant long-term Kmax reduction and visual stability. The absence of endothelial damage or stromal complications confirms its long-term safety. Short procedure time and epithelial preservation make this approach particularly suitable for young and pediatric populations.
Further prospective comparative studies are warranted to confirm these long-term findings.