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Progression of pediatric keratoconus following corneal cross-linking: a systematic review and pooled analysis

Poster Details

First Author: A. Achiron ISRAEL

Co Author(s):    O. El-Hadad   D. Leadbetter   I. Hecht   A. Venkata   D. Tole   K. Darcy     

Abstract Details


Corneal collagen cross-linking (CXL) is an effective treatment to arrest Keratoconus (KC) progression in adults. Several studies have also shown efficacious outcomes in pediatric populations, yet no systematic analysis has been performed and no accepted definition for progression is available in children after CXL. This study aimed to establish the most commonly used criteria for progression and perform a systematic review of the literature with pooled analysis to assess the progression of keratoconus in children after CXL.


A systemic literature review


A systemic literature review combined with pooled analysis was performed on full-length Studies of KC after CXL treatment in a pediatric population were included and the methods used to report progression were analyzed.


Thirty-Three studies (1841 eyes) were identified on rates of KC progression after CXL. The most common method to report progression was an increase in Kmax, Kmean, or Ksteep by ?1.0 diopter (75.7% of studies). Using this criteria the mean pooled progression rate following epithelium-off CXL was 10.6% (95% CI: 6.2% - 15.9%, total pooled sample size: 1271 eyes) with high heterogeneity between studies (I2=86.45% (95% CI: 80.24 - 90.71), P < 0.0001).


When considering KC progression following CXL in children an increase in Kmax, Kmean, or Ksteep?1.0 diopter the risk of progression was 10.6%. We encourage clear quantitative reporting of KC progression in future studies evaluating CXL efficacy in pediatric populations.

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