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Three-year follow-up of accelerated transepithelial corneal cross-linking for progressive paediatric keratoconus
  1. Mi Tian1,2,
  2. Weijun Jian1,2,
  3. Xiaoyu Zhang1,2,
  4. Ling Sun1,2,
  5. Xingtao Zhou1,2
  1. 1Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
  2. 2NHC Key Laboratory of Myopia, Shanghai, China
  1. Correspondence to Dr Xingtao Zhou, Fudan University, Shanghai 200433, China; doctzhouxingtao{at}


Purpose To investigate the long-term safety and efficacy of accelerated transepithelial cornealcross-linking (ATE-CXL) in children with progressive keratoconus.

Methods Fifty-three eyes of 41 paediatric patients (34 boys, 7 girls; mean age 14.81±1.96 years) undergoing ATE-CXL were enrolled in the study. Corrected distance visual acuity (CDVA) and manifest refraction were assessed preoperatively and 36 months postoperatively. Corneal keratometry, corneal thickness and posterior elevation were measured using Pentacam preoperatively and 1, 6, 12 and 36 months postoperatively. Pachymetry and epithelial thicknesses were measured using optical coherence tomography preoperatively and 6, 12, and 36 months postoperatively.

Results Thirty-six months postoperatively, CDVA improved from 0.32±0.28 to 0.26±0.25 in logarithm of the minimum angle resolution (p=0.025). Maximum keratometry was 58.73±9.70 D preoperatively and 59.20±10.24, 58.28±9.33, 57.88±9.99 and 58.98±10.79 D at 1, 6, 12 and 36 months postoperatively throughout the 36-month follow-up period (p>0.05). Similarly, corneal central thickness, which was 492.42±33.83 µm postoperatively, also remained stable during the 36-month follow-up (p>0.05). Both posterior central elevation and posterior highest elevation were stable at 12 months after ATE-CXL (p>0.05), but increased at 36 months postprocedure (p<0.05). Corneal pachymetry and epithelial thicknesses remained stable throughout the follow-up period (p>0.05).

Conclusions ATE-CXL is a safe and effective treatment in paediatric progressive keratoconus patients, leading to stable keratometry and corneal thickness throughout the 36-month follow-up.

  • cornea

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  • MT and WJ contributed equally.

  • Contributors Study concept and design (MT and XZha); data collection (MT, WJ, XZho and LS); analysis and interpretation of data (MT, WJ and LS); writing the manuscript (MT and WJ); critical revision of the manuscript (XZha); statistical expertise (MT and WJ); administrative, technical or material support (XZha and XZho); supervision (XZho)

  • Funding This work was supported by XZho from the National Natural Science Foundation of China (grant no. 81570879); by XZha from the National Natural Science Foundation of China for Young Scholars (grant no. 11702063).

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Ethics approval This study was approved by the Ethics Committee of the Eye and ENT Hospital of Fudan University and adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available from the corresponding author ( on reasonable request.

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