{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:24:35Z","timestamp":1788269075584,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the predictive factors for successful corneal collagen cross-linking (CXL) in pediatric patients with Keratoconus (KC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study was conducted using a prospectively built database. Patients (18\u2009years old or younger) underwent CXL for KC between 2007 and 2017, with a 1-year follow-up period or longer. The outcomes included changes in Kmax (delta [\u0394] Kmax\u2009=\u2009Kmax<jats:sub>last<\/jats:sub> \u2212\u2009Kmax<jats:sub>pre<\/jats:sub>) and LogMAR visual acuity (\u0394LogMAR\u2009=\u2009LogMAR<jats:sub>last<\/jats:sub> \u2212\u2009LogMAR<jats:sub>pre<\/jats:sub>).<\/jats:p><jats:p>The effects of CXL type (accelerated or non-accelerated), demographics (age, sex, background of ocular allergy, ethnicity), preoperative LogMAR visual acuity, maximal corneal power (Kmax), pachymetry (CCT<jats:sub>pre<\/jats:sub>), refractive cylinder, and follow-up (FU) time on the outcomes were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred thirty-one eyes of 110 children were included (mean age, 16\u2009\u00b1\u20092\u2009years; range, 10\u201318\u2009years). Kmax and LogMAR improved from baseline to last visit: from 53.81 D\u2009\u00b1\u20096.39 D to 52.31 D\u2009\u00b1\u20096.06 D (<jats:italic>p<\/jats:italic> &amp;lt;\u20090.001) and from 0.27\u2009\u00b1\u20090.23 LogMAR units to 0.23\u2009\u00b1\u20090.19 LogMAR units (<jats:italic>p<\/jats:italic> =\u20090.005), respectively. A negative \u0394Kmax (meaning corneal flattening) was associated with a long FU, low CCT<jats:sub>pre<\/jats:sub>, high Kmax<jats:sub>pre<\/jats:sub>, high LogMAR<jats:sub>pre,<\/jats:sub> and non-accelerated CXL on univariate analysis. High Kmax<jats:sub>pre<\/jats:sub> and non-accelerated CXL were associated with negative \u0394Kmax in the multivariate analysis.<\/jats:p><jats:p>A negative \u0394LogMAR (meaning vision improvement) was associated with a high LogMAR<jats:sub>pre<\/jats:sub> in univariate analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CXL is an effective treatment option in pediatric patients with KC. Our results showed that the non-accelerated treatment was more effective than the accelerated treatment. Corneas with advanced disease had a greater effect on CXL.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1149641","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T06:24:19Z","timestamp":1683872659000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Outcome indicators for cross linking in pediatric 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