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.