{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:24:07Z","timestamp":1787757847128,"version":"build-2784847793"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Purpose:<\/jats:title>\n \n To assess the one-year visual, refractive, and tomographic outcomes of corneal collagen cross-linking (CXL) performed\n at diagnosis<\/jats:italic>\n in Indian children with keratoconus and to evaluate its safety in eyes with controlled vernal keratoconjunctivitis (VKC).\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Thirty-eight eyes of 30 children (9\u201318 years) diagnosed with keratoconus underwent standard epithelium-off CXL (Dresden protocol). \u201cAt diagnosis\u201d was defined as treatment within four weeks of first topographic confirmation. Outcome measures included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), mean refractive spherical equivalent (MRSE), keratometric indices (flat K, steep K, apical K), pachymetry, and endothelial cell density. Statistical analysis included paired and adjusted comparisons with 95% confidence intervals (CIs).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n UCVA improved from 0.72 \u00b1 0.46 to 0.45 \u00b1 0.42 logMAR (\n P<\/jats:italic>\n < 0.001) and BCVA from 0.37 \u00b1 0.30 to 0.21 \u00b1 0.28 logMAR (\n P<\/jats:italic>\n < 0.001). MRSE improved by 1.72 D (\n P<\/jats:italic>\n < 0.001). Steep K and apical K flattened by 2.02 D and 2.26 D respectively (\n P<\/jats:italic>\n < 0.001). Endothelial cell counts were stable. Subgroup analysis showed no difference between VKC and non-VKC eyes. Three patients developed transient sterile infiltrates that resolved with medical therapy.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Performing CXL at diagnosis is safe and effective in halting pediatric keratoconus progression while improving visual and refractive outcomes. Early treatment is particularly relevant for high-risk ethnic groups such as Indian children, where keratoconus is aggressive and rapidly progressive.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijo.ijo_2328_25","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T10:00:20Z","timestamp":1770804020000},"page":"S261-S266","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Corneal collagen cross-linking at diagnosis in pediatric keratoconus: A prospective study from the Indian Subcontinent"],"prefix":"10.4103","volume":"74","author":[{"given":"Ritu","family":"Arora","sequence":"first","affiliation":[{"name":"Department of Cornea and Refractive Surgery, Shroff Eye Centre, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parul","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Cornea and Refractive Surgery, Guru Nanak Eye Centre, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trushaa","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Cornea and Refractive Surgery, Indore, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"R1-20260813","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/0002-9394(86)90817-2","article-title":"A 48-year clinical and epidemiologic study of keratoconus","volume":"101","author":"Kennedy","year":"1986","journal-title":"Am J Ophthalmol"},{"key":"R2-20260813","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/00003226-199603000-00006","article-title":"Biomicroscopic signs and disease severity in keratoconus: The CLEK 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riboflavin and ultraviolet-A light in keratoconus: Long-term results","volume":"34","author":"Raiskup-Wolf","year":"2008","journal-title":"J Cataract Refract Surg"},{"key":"R10-20260813","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.ophtha.2008.09.048","article-title":"Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking","volume":"116","author":"Vinciguerra","year":"2009","journal-title":"Ophthalmology"},{"key":"R11-20260813","doi-asserted-by":"crossref","first-page":"330","DOI":"10.3928\/01913913-20110614-02","article-title":"Corneal crosslinking for progressive keratoconus in four children","volume":"48","author":"Soeters","year":"2011","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"R12-20260813","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5005\/jp-journals-10025-1009","article-title":"Corneal cross-linking for progressive keratoconus in children: our experience","volume":"1","author":"Bakshi","year":"2012","journal-title":"Int J Keratoconus Ectatic Corneal Dis"},{"key":"R13-20260813","first-page":"1531","article-title":"A clinical prediction model for progression of keratoconus","volume":"37","author":"Wisse","year":"2018","journal-title":"Cornea"},{"key":"R14-20260813","first-page":"408","article-title":"Progression of keratoconus and efficacy of pediatric corneal collagen cross-linking in children and adolescents","volume":"35","author":"Chatzis","year":"2019","journal-title":"J Refract Surg"},{"key":"R15-20260813","first-page":"2749","article-title":"Clinical profile and treatment outcomes of pediatric keratoconus in India","volume":"68","author":"Mukherjee","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"R16-20260813","first-page":"117","article-title":"Results of corneal collagen cross-linking in pediatric patients with keratoconus","volume":"21","author":"Arora","year":"2012","journal-title":"J Refract 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