Outcomes of accelerated corneal cross-linking for pediatric and adult keratoconus: a comparative study

Purpose To compare the visual, refractive, and topographic outcomes of a high irradiance accelerated corneal crosslinking (ACXL) protocol after a 12-month follow-up between pediatric and adult patients with progressive keratoconus (KC). Methods Retrospective, comparative, cohort study. Patients with KC were divided into two groups: pediatric (≤ 18 years) and adult (> 18 years). All of them were managed with epi-OFF ACXL (30 mW/cm 2 , 8 min, pulsed 1:1 on and off = 7.2 J/cm 2 ). Visual, refractive, and topographic values were measured preoperatively and at 1, 3, 6, and 12 months postoperative. KC progression, defined as a K max increase of ≥ 1D during follow-up, was recorded. Results Eighty-nine eyes (53 patients) were included for analysis; 45 (50.6%) eyes were from pediatric patients and 44 (49.4%) from adults. At one-year follow-up, pediatric patients experienced significantly higher rates of progression (22.2% vs. 4.5%, p = .014). Contrariwise, female gender (Beta = − 3.62, p = .018), a baseline uncorrected visual acuity of Snellen ≥ 20/60 (Beta = − 5.96, p = .007), and being ≥ 15 years at ACXL treatment (Beta = − 0.31, p = .021) were associated with non-progressive disease. A significant improvement in best-corrected visual acuity, K min , K m , and K max was recorded in both groups. Overall, 86.5% of eyes from both groups showed K max stabilization or improvement. Conclusions Despite the similarity in visual, refractive, and topographic outcomes in both groups, younger age was associated with KC progression after ACXL at one year of follow-up.