{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:59:04Z","timestamp":1783724344346,"version":"3.55.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T00:00:00Z","timestamp":1647475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["NSFC 82000937"],"award-info":[{"award-number":["NSFC 82000937"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009377","name":"Education Department of Hunan Province","doi-asserted-by":"publisher","award":["2020JGZDO11"],"award-info":[{"award-number":["2020JGZDO11"]}],"id":[{"id":"10.13039\/100009377","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010083","name":"Hunan Provincial Innovation Foundation for Postgraduate","doi-asserted-by":"publisher","award":["CX20200317"],"award-info":[{"award-number":["CX20200317"]}],"id":[{"id":"10.13039\/501100010083","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011790","name":"Xiangya Hospital, Central South University","doi-asserted-by":"publisher","award":["2020JGA008"],"award-info":[{"award-number":["2020JGA008"]}],"id":[{"id":"10.13039\/501100011790","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of the study is to compare the efficacy of standard epithelium-off CXL (SCXL), accelerated epithelium-off CXL (ACXL), and transepithelial crosslinking CXL (TECXL) for pediatric keratoconus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature search on the efficacy of SCXL, ACXL, and TECXL [including accelerated TECXL (A-TECXL)] for keratoconus patients younger than 18 years was conducted using PubMed, Cochrane Library, <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>, and EMBASE up to 2021. Primary outcomes were changes in uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) after CXL. Secondary outcomes were changes in best-corrected visual acuity (BCVA), mean refractive spherical equivalent (MRSE), and central corneal thickness (CCT). Estimations were analyzed by weighted mean difference (WMD) and 95% confidence interval (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A number of eleven identified studies enrolled 888 eyes (SCXL: 407 eyes; ACXL: 297 eyes; TECXL: 28 eyes; A-TECXL: 156 eyes). For pediatric keratoconus, except for a significant greater improvement in BCVA at 24-month follow-up in SCXL (WMD = \u20130.08, 95%CI: \u20130.14 to \u20130.01, <jats:italic>p<\/jats:italic> = 0.03, I<jats:sup>2<\/jats:sup> = 71%), no significant difference was observed in other outcomes between the SCXL and ACXL groups. SCXL seems to provide greater changes in UCVA (WMD = \u20130.24, 95% CI: \u20130.34 to \u20130.13, <jats:italic>p<\/jats:italic> &amp;lt; 0.00001, I<jats:sup>2<\/jats:sup> = 89%), BCVA (WMD = \u20130.09, 95% CI: \u20130.15 to \u20130.04, <jats:italic>p<\/jats:italic> = 0.0008, I<jats:sup>2<\/jats:sup> = 94%), and Kmax (WMD = \u20131.93, 95% CI: \u20133.02 to \u20130.85, <jats:italic>p<\/jats:italic> = 0.0005, I<jats:sup>2<\/jats:sup> = 0%) than A-TECXL, with higher incidence of adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For pediatric keratoconus, both SCXL and ACXL appear to be comparable in the efficacy of visual effects and keratometric outcomes; SCXL seems to provide greater changes in visual and pachymetric outcomes than A-TECXL.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.787167","type":"journal-article","created":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T05:23:32Z","timestamp":1647494612000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Comparison of Efficacy and Safety Between Standard, Accelerated Epithelium-Off and Transepithelial Corneal Collagen Crosslinking in Pediatric Keratoconus: A 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