Efficacy and Safety of 7.2 J/cm² Accelerated Corneal Cross-Linking in Pediatric and Adult Keratoconus: A Comparative Study.

Purpose: To evaluate and compare the short-term outcomes of an accelerated corneal crosslinking (CXL) protocol with a total energy dose of 7.2 J/cm² in pediatric and adult keratoconus patients.

Methods: This study included 113 eyes of 82 keratoconus patients who underwent accelerated epithelium-off CXL (12 mW/cm² for 10 minutes) at a university hospital. Patients were divided into two groups based on age: ≤18 years (Group 1, n=48 eyes) and >18 years (Group 2, n=65 eyes). Preoperative and postoperative (6-month) uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), keratometric indices (K1, K2, Kmax, Km), central corneal thickness (CCT), and endothelial cell density (ECD) were analyzed and compared between groups.

Results: Significant improvements in BCVA and reductions in keratometric indices were observed in both groups (p < 0.05). While both groups demonstrated significant visual and structural improvements, the adult group exhibited a greater magnitude of change in most keratometric and refractive parametersGroup 1 (mean age 15.4 ± 1.6 years) and Group 2 (mean age 23.4 ± 3.4 years) exhibited significant decreases in CCT (p < 0.001). Posterior keratometric values showed statistically significant changes in both groups (p < 0.001). ECD remained stable, and no severe complications were noted.

Conclusions: Accelerated CXL with a total energy dose of 7.2 J/cm² demonstrated a favorable safety profile and significant efficacy in stabilizing keratoconus in both pediatric and adult patients over a 6-month period. Notably, adult patients exhibited a greater extent of keratometric and refractive improvement, suggesting a potentially age-dependent biomechanical response. These findings support the utility of this protocol as an early intervention strategy, particularly in young adults with progressive disease.