Cross-linking in Children

Keratoconus is a disease of young people and is most common and most aggressive in children (8 to 15 years) and adolescents (10 to 19 years). It is therefore very important to carry out regular follow-up checks here. Above all, the children of adult patients with keratoconus should also be examined.

Our group has one of the longest international experiences in the treatment of children and adolescents. This particular age group requires special care and attention because the risk of postoperative complications such as infection can be greatly increased.

Immediate treatment

Unlike adults, children and adolescents are immediately cross-linked as soon as the keratoconus is clearly diagnosed. So there are no historical controls planned to prove the deterioration.

This is because one of the first major studies of CXL in children (in 2012) clearly showed that keratoconus worsened in 88% of all children and adolescents aged 8 to 19. This study comes from our research group. These results made it clear that if the disease worsens in 9 out of 10 children and adolescents, there should be no hesitation in treating the condition immediately.

We do not want to take the slightest risk with children and therefore use the best-documented cross-linking protocol: epithelium-off CXL, 3 mW/cm², 30 minutes of radiation. The success rate of this conventional and “slow” protocol is more than 95%.


The results of cross-linking in children and adolescents as excellent as they are in adults: the disease can be stopped with a high rate of success. In adults, we usually have to wait six months to see if the treatment has succeeded, but often, we can determine success after just three months in children and adolescents often see the CXL succeed after just three months.

The effect is greater in children

Extreme improvement

We often see children react more clearly and more strongly than adults. The topography below shows a remarkable result early after crosslinking the right eye: the cornea not only stabilized, but also underwent a flattening of more than 5 diopters after 7 months.

7 months after CXL

Before CXL


Faster deterioration

A 15-year-old boy with a decrease in visual acuity in his right eye who started 3 months ago. The patient and his parents were asked to come to follow-up after 4 weeks. Unfortunately, they did not reappear until 3 months later. The right picture shows the massive deterioration after just 3 months.

September 2009

May 2009


The procedure

Cross-linking in children and adolescents is exactly the same as for adults. Because the treatment is painless, we can also treat children over the age of 9 under local anaesthesia. For children under the age of 9 years, if necessary, we will perform the treatment under general anaesthesia: our anaesthetists will discuss this with you separately.

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The ELZA Institute was represented at the 2018 Meeting of the Moroccon Cataract and Refractive Surgeons in Tanger

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