Comparative effectiveness of accelerated and standard corneal cross-linking in pediatrics: a systematic review and meta-analysis.
Yousef Mesaed Al-Shammari, Faisal Aljassar, Shaikhah Mesaed Al-Shammari et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared accelerated with standard epithelium-off corneal cross-linking (CXL) for pediatric keratoconus. Eight studies included 571 eyes from 464 patients younger than 18 years. Pooled analyses found no significant differences in spherical equivalent (MD = - 0.02, P = 0.84), uncorrected or best-corrected visual acuity, or maximum keratometry (MD = 0.28, P = 0.72). The authors report that accelerated CXL has shorter procedure times, but note that long-term safety and durability remain to be confirmed.
Key findings
- Spherical equivalent did not differ significantly between accelerated and standard CXL (MD = - 0.02, P = 0.84).
- No significant differences were found in uncorrected visual acuity (MD = - 0.06, P = 0.08) or best-corrected visual acuity (MD = - 0.02, P = 0.47).
- Maximum keratometry showed no significant difference (MD = 0.28, P = 0.72), with high heterogeneity across studies.
- The review included eight studies covering 571 eyes and 464 pediatric patients.
Why it matters
The findings suggest that shorter-duration CXL protocols may achieve visual and topographic outcomes comparable to standard CXL in children over the periods studied. This comparison is relevant when considering procedural efficiency, while the evidence does not establish long-term equivalence or durability.
What to keep in mind
The authors state that long-term safety and durability require further confirmation. Heterogeneity was high for maximum keratometry.