Corneal Cross-linking in Pediatric Populations: Systematic Review and Future Perspectives.

PURPOSE: To analyze stabilization results using various standard and accelerated corneal cross-linking (CXL) protocols in patients younger than 18 years.

METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. A bibliographic search was carried out based on PubMed and Scopus data, with the last being performed in December 2024. Thirty-five articles were eligible for this review. To assess the effectiveness of CXL in children, maximum keratometry measurements were analyzed preoperatively and compared with postoperative values.

RESULTS

A total of 2,186 eyes were included in this review. This review consisted of 15 studies with the standard CXL protocol, 11 with the accelerated CXL protocol, and 9 comparative protocols. Standard and accelerated CXL protocols and comparative studies were analyzed separately. Most studies have shown stabilization rates greater than 80% with different CXL protocols. Factors such as younger age, severity of keratoconus, and cone eccentricity seem to influence the effectiveness of the procedure.

CONCLUSIONS

The results indicate that standard and accelerated CXL are effective and safe therapeutic options for treating keratoconus in pediatric population.