{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T01:35:17Z","timestamp":1779240917940,"version":"3.51.4"},"reference-count":26,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T00:00:00Z","timestamp":1725321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Aim: The aim of this study was to evaluate corneal cross-linking (CXL) for keratoconus in pediatric patients. Materials and methods: After keratometric qualification according to the Amsler\u2013Krumeich system, corneal collagen cross-linking was performed using ultraviolet light and photosensitizing riboflavin drops in 111 eyes of 74 children with a mean age of 15 \u00b1 1.67 years. None of the children studied wore contact lenses before the procedure. Visual acuity, intraocular pressure, keratometry, and pachymetry parameters were analyzed before and after corneal cross-linking. Results: Visual acuity was 0.64 \u00b1 0.31 and 0.66 \u00b1 0.29 before CXL and at the end of the follow-up, respectively; the difference was not statistically significant. The mean intraocular pressure before CXL was 14.48 \u00b1 3.13 mmHg, while the mean value at the end of the follow-up was 14.23 \u00b1 3.03 mmHg; no statistically significant difference was found. Pre- and post-CXL astigmatism was 3.98 \u00b1 2.34 Dcyl and 3.63 \u00b1 1.86 Dcyl, respectively; the difference was not statistically significant. The mean keratometry before CXL was 47.99 \u00b1 3.96 D; the mean post-follow-up value was 47.74 \u00b1 3.63 D. The mean corneal thickness (pachymetry) at the apex of the keratoconus\u2014the thinnest zone of the cornea\u2014before CXL was 492.16 \u00b1 38.75 \u00b5m, while the mean value at the end of the follow-up was 479.99 \u00b1 39.71 \u00b5m; the difference was statistically significant. Conclusions: Corneal cross-linking is an effective method for preventing keratoconus progression in children. However, further and detailed ophthalmic follow-up of patients who underwent CXL before the age of 18 is highly advisable.<\/jats:p>","DOI":"10.3390\/diagnostics14171950","type":"journal-article","created":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T08:38:47Z","timestamp":1725352727000},"page":"1950","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Corneal Cross-Linking for Pediatric Keratoconus"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6753-2904","authenticated-orcid":false,"given":"Bogumi\u0142a","family":"W\u00f3jcik-Niklewska","sequence":"first","affiliation":[{"name":"Department of Pediatric Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"},{"name":"Professor Kornel Gibi\u0144ski University Hospital Center, Medical University of Silesia, 40-514 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4227-1349","authenticated-orcid":false,"given":"Erita","family":"Filipek","sequence":"additional","affiliation":[{"name":"Department of Pediatric Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"},{"name":"Professor Kornel Gibi\u0144ski University Hospital Center, Medical University of Silesia, 40-514 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0910-3578","authenticated-orcid":false,"given":"Pawe\u0142","family":"Janik","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, Faculty of Science and Technology, University of Silesia in Katowice, 39 B\u0119dzi\u0144ska Street, 41-200 Sosnowiec, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101559","DOI":"10.1016\/j.clae.2021.101559","article-title":"Keratoconus: An updated review","volume":"45","author":"Carracedo","year":"2022","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1038\/eye.2013.278","article-title":"The pathogenesis of keratoconus","volume":"28","author":"Davidson","year":"2014","journal-title":"Eye"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1136\/bjophthalmol-2015-307059","article-title":"Management of advanced corneal ectasias","volume":"100","author":"Maharana","year":"2016","journal-title":"Br. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"El Rami, H., Chelala, E., Dirani, A., Fadlallah, A., Fakhoury, H., Cherfan, C., Cherfan, G., and Jarade, E. (2015). An Update on the Safety and Efficacy of Corneal Collagen Cross-Linking in Pediatric Keratoconus. Biomed. Res. Int., 2015.","DOI":"10.1155\/2015\/257927"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/ICO.0000000000000408","article-title":"Global consensus on keratoconus and ectatic diseases","volume":"34","author":"Gomes","year":"2015","journal-title":"Cornea"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1097\/ICO.0000000000002420","article-title":"Keratoconus in Children: A Literature Review","volume":"39","author":"Buzzonetti","year":"2020","journal-title":"Cornea"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/S0002-9394(02)02220-1","article-title":"Riboflavin\/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus","volume":"135","author":"Wollensak","year":"2003","journal-title":"Am. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.survophthal.2023.09.005","article-title":"Refractive surgical correction and treatment of keratoconus","volume":"69","author":"Bagaglia","year":"2024","journal-title":"Surv. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1016\/S0886-3350(03)00407-3","article-title":"Stress-strain measurements of human and porcine corneas after riboflavin-ultraviolet-A-induced cross-linking","volume":"29","author":"Wollensak","year":"2003","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/01.ico.0000105827.85025.7f","article-title":"Collagen fiber diameter in the rabbit cornea after collagen crosslinking by riboflavin\/UVA","volume":"23","author":"Wollensak","year":"2004","journal-title":"Cornea"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/ICO.0000000000000723","article-title":"Efficacy of Corneal Collagen Cross-Linking for the Treatment of Keratoconus: A Systematic Review and Meta-Analysis","volume":"35","author":"Meiri","year":"2016","journal-title":"Cornea"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s40123-022-00508-9","article-title":"Pediatric Crosslinking: Current Protocols and Approach","volume":"11","author":"Polido","year":"2022","journal-title":"Ophthalmol. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1007\/s40123-020-00306-1","article-title":"Post-FDA Approval Results of Epithelium-Off, Full-Fluence, Dresden Protocol Corneal Collagen Crosslinking in the USA","volume":"9","author":"Ansah","year":"2020","journal-title":"Ophthalmol. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.survophthal.2015.04.002","article-title":"Corneal cross-linking","volume":"60","author":"Randleman","year":"2015","journal-title":"Surv. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/ICU.0000000000000146","article-title":"Current and future applications of corneal cross-linking","volume":"26","author":"Khandelwal","year":"2015","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"454","DOI":"10.3928\/1081597X-20140527-03","article-title":"Corneal cross-linking for treatment of progressive keratoconus in various age groups","volume":"30","author":"Soeters","year":"2014","journal-title":"J. Refract. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"753","DOI":"10.3928\/1081597X-20121011-01","article-title":"Progression of keratoconus and efficacy of pediatric [corrected] corneal collagen cross-linking in children and adolescents","volume":"28","author":"Chatzis","year":"2012","journal-title":"J. Refract. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1097\/ICO.0b013e31826cf32d","article-title":"Epithelium-off corneal collagen cross-linking versus transepithelial cross-linking for pediatric keratoconus","volume":"32","author":"Magli","year":"2013","journal-title":"Cornea"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Shetty, R., Nagaraja, H., Jayadev, C., Pahuja, N.K., Kurian Kummelil, M., and Nuijts, R.M. (2014). Accelerated corneal collagen cross-linking in pediatric patients: Two-year follow-up results. Biomed. Res. Int., 2014.","DOI":"10.1155\/2014\/894095"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"759","DOI":"10.3928\/1081597X-20121011-02","article-title":"Results of corneal collagen cross-linking in pediatric patients","volume":"28","author":"Arora","year":"2012","journal-title":"J. Refract. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.jcrs.2013.03.017","article-title":"Transepithelial corneal collagen crosslinking for progressive keratoconus in a pediatric age group","volume":"39","author":"Salman","year":"2013","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.ajo.2012.03.020","article-title":"Two-year corneal cross-linking results in patients younger than 18 years with documented progressive keratoconus","volume":"154","author":"Vinciguerra","year":"2012","journal-title":"Am. J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/ICO.0b013e31822159f6","article-title":"Riboflavin-UVA-induced corneal collagen cross-linking in pediatric patients","volume":"31","author":"Caporossi","year":"2012","journal-title":"Cornea"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.ajo.2009.10.021","article-title":"Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: The Siena eye cross study","volume":"149","author":"Caporossi","year":"2010","journal-title":"Am. J. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jaapos.2020.01.015","article-title":"Technique for pediatric corneal crosslinking under general anesthesia","volume":"24","author":"Fung","year":"2020","journal-title":"J. AAPOS"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e246141","DOI":"10.1136\/bcr-2021-246141","article-title":"Rapid spontaneous resolution of corneal hydrops in post-CXL keratitis","volume":"14","author":"Varshney","year":"2021","journal-title":"BMJ Case Rep."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/17\/1950\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:47:56Z","timestamp":1760111276000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/17\/1950"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,3]]},"references-count":26,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["diagnostics14171950"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14171950","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,3]]}}}