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Purpose <p>To evaluate the 12&#xa0;month visual, refractive, and tomographic outcomes of pulsed accelerated corneal collagen cross-linking (PACXL) in children with progressive keratoconus and to determine its safety and efficacy in an Indian pediatric cohort.</p> Methods <p>This was a prospective interventional study including 40 eyes of 31 children (&lt; 18&#xa0;years) with progressive keratoconus and a minimum corneal thickness ≥ 400&#xa0;µm. All eyes underwent epithelium-off PACXL (9&#xa0;mW/cm<sup>2</sup>, 10&#xa0;s on/5&#xa0;s off, total 5.4&#xa0;J/cm<sup>2</sup>) using the PXL Platinum 330 system. The total procedure time was around 45&#xa0;min i.e. 30&#xa0;min of riboflavin instillation and 15&#xa0;min of UV-A irradiation. Standard postoperative steroid and antibiotic regimens were followed. Outcomes at 12&#xa0;months included uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA, logMAR), maximum keratometry (Kmax), manifest refraction, pachymetry, endothelial cell density, and postoperative complications.</p> Results <p>The mean age was 15.4 ± 1.5&#xa0;years (64.5% male). At 12&#xa0;months, mean BSCVA improved from 0.31 ± 0.21 to 0.23 ± 0.22 logMAR (p = 0.005) and UCVA from 0.79 ± 0.46 to 0.71 ± 0.47 logMAR (p &lt; 0.001). Mean Kmax decreased from 57.38 ± 6.22 to 56.8 ± 5.6&#xa0;D. Median refractive cylinder reduced from − 2.0 to − 1.12&#xa0;D (p = 0.036). Mean thinnest pachymetry declined from 446.15 ± 25.5 to 398.7 ± 43.7&#xa0;µm (p &lt; 0.001), indicating stromal compaction or possible stromal volume loss. Endothelial cell density remained stable (2843.9 ± 247 → 2828.3 ± 234 cells/mm<sup>2</sup>; p = 0.092). At 12&#xa0;months, 34/40 eyes (85%) were stable; 6 eyes (15%) progressed (defined as Kmax increase ≥ 1.0 D), all with advanced baseline disease. Three eyes (7.5%) developed transient sterile infiltrates that resolved with topical steroids. No infectious keratitis or endothelial loss occurred.</p> Conclusions <p>Pulsed accelerated CXL provided significant visual improvement and 85% topographic stabilization at 12&#xa0;months in pediatric keratoconus, with no endothelial toxicity. It offers a time-efficient and safe early-intervention option for children in whom standard protocols are less feasible.</p>

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Pulsed accelerated corneal cross-linking for pediatric keratoconus: a prospective study from the Indian subcontinent

  • 期刊论文

  • 发表日期：

    2026年7月7日

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  • Parul Jain,
  • Arun Mehta,
  • Ritu Arora,
  • Isha Gupta,
  • Paromita Dutta,
  • Vanditaa Agrrawal,
  • Vardayani Mehta

摘要

Purpose

To evaluate the 12 month visual, refractive, and tomographic outcomes of pulsed accelerated corneal collagen cross-linking (PACXL) in children with progressive keratoconus and to determine its safety and efficacy in an Indian pediatric cohort.

Methods

This was a prospective interventional study including 40 eyes of 31 children (< 18 years) with progressive keratoconus and a minimum corneal thickness ≥ 400 µm. All eyes underwent epithelium-off PACXL (9 mW/cm2, 10 s on/5 s off, total 5.4 J/cm2) using the PXL Platinum 330 system. The total procedure time was around 45 min i.e. 30 min of riboflavin instillation and 15 min of UV-A irradiation. Standard postoperative steroid and antibiotic regimens were followed. Outcomes at 12 months included uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA, logMAR), maximum keratometry (Kmax), manifest refraction, pachymetry, endothelial cell density, and postoperative complications.

Results

The mean age was 15.4 ± 1.5 years (64.5% male). At 12 months, mean BSCVA improved from 0.31 ± 0.21 to 0.23 ± 0.22 logMAR (p = 0.005) and UCVA from 0.79 ± 0.46 to 0.71 ± 0.47 logMAR (p < 0.001). Mean Kmax decreased from 57.38 ± 6.22 to 56.8 ± 5.6 D. Median refractive cylinder reduced from − 2.0 to − 1.12 D (p = 0.036). Mean thinnest pachymetry declined from 446.15 ± 25.5 to 398.7 ± 43.7 µm (p < 0.001), indicating stromal compaction or possible stromal volume loss. Endothelial cell density remained stable (2843.9 ± 247 → 2828.3 ± 234 cells/mm2; p = 0.092). At 12 months, 34/40 eyes (85%) were stable; 6 eyes (15%) progressed (defined as Kmax increase ≥ 1.0 D), all with advanced baseline disease. Three eyes (7.5%) developed transient sterile infiltrates that resolved with topical steroids. No infectious keratitis or endothelial loss occurred.

Conclusions

Pulsed accelerated CXL provided significant visual improvement and 85% topographic stabilization at 12 months in pediatric keratoconus, with no endothelial toxicity. It offers a time-efficient and safe early-intervention option for children in whom standard protocols are less feasible.