Primary Outcomes of Accelerated Epithelium-Off Corneal Cross-Linking in Progressive Keratoconus in Children: A 1-Year Prospective Study.

Purpose: To evaluate corneal transparency following accelerated collagen cross-linking (ACXL) in pediatric keratoconus.

Design: A prospective interventional case series.

Methods: This study included 47 eyes (25 patients), aged 9-14 years, with documented progressive keratoconus. After applying 0.1% riboflavin drops, ACXL was performed. Assessment included corrected distance visual acuity (CDVA), uncorrected visual acuity (UCVA), corneal haze, and corneal densitometry in grayscale units (GSU).

Result: The mean baseline and corneal densitometry peaked at 3 months post-ACXL while central and posterior densitometry showed a statistically significant increase ( P < 0.05) and peaked at 8 months postoperatively. By 12 months, densitometry in all corneal layers ( P ≥ 0.99) and concentric zones ( P ≥ 0.97) reached near baseline values. Slit-lamp graded haze peaked at 1 month to 1.82 ± 0.65 ( P < 0.05) and declined to near baseline at 12 months (0.39 ± 0.58). There was a statistically significant increase in the mean UCVA and CDVA at 12 months.

Conclusion: Total and anterior corneal densitometry peaked after 3 months, while central and posterior densitometry peaked after 8 months. Maximum haze was at 1 month post-ACXL. All corneal layers, concentric zone densitometry and haze reached near baseline values after 1 year. Scheimpflug densitometry showed weak correlation with CDVA over the 12-month follow-up period ( r = -0.193).