Visual and Topographic Outcomes of Accelerated Corneal Cross-Linking for Keratoconus in Indigenous and Non-Indigenous Children in Australia

Purpose: To review outcomes in visual acuity, astigmatism, keratometry, and pachymetry following an accelerated corneal cross-linking (CXL) epithelium-off procedure in children with keratoconus. Methods: Single-center, retrospective cohort study of all patients who underwent an accelerated CXL procedure from November 2018 to June 2023. Data were collected on baseline metrics (corrected distance visual acuity, astigmatism, pachymetry, maximum keratometry) and follow-up changes at 6 and 12 months postprocedure. Results: Fifty-nine eyes of 43 patients who underwent accelerated CXL were reviewed. At 6 months, there was an overall reduction in the Kmax (P = 0.029) and pachymetry (P = 0.012) but no significant changes in topographic astigmatism (P = 0.751) or corrected distance visual acuity (P = 0.613). At 12 months, there was no statistically significant evidence of change in any outcome, but the analyzable sample was small, so the results at 12 months should be interpreted as inconclusive. No statistically significant associations were identified between Aboriginal and Torres Strait Islander (ATSI) status and the four outcomes across the 6- and 12-month time points. Conclusions: The findings revealed that accelerated CXL is an effective procedure that halts the progression of keratoconus at 6 months postprocedure in a pediatric population. It provides the advantage of a shorter-duration procedure compared with standard CXL. Translational Relevance: Accelerated CXL for pediatric keratoconus was associated with corneal topographic stabilization, with significant Kmax improvement at 6 months, despite a reduction in corneal thickness. These findings suggest that when assessing disease progression versus stabilization following CXL, the postoperative pachymetry changes should be reviewed alongside clinical and tomographic changes. Additionally, we observed no significant associations between ATSI status and the measured outcomes, suggesting that ATSI status is not associated with clinical response to CXL in this cohort.