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Background  Keratoconus typically presents in the teenage years and is more advanced in younger patients when compared with adults. In the present study, we aimed to assess the safety and efficacy of accelerated transepithelial corneal collagen cross-linking (ATE-CXL) in children with progressive keratoconus.    Methods  In this retrospective consecutive study, 18 eyes were enrolled from 17 pediatric patients (15 boys and 2 girls) with a mean age of 14.44 ± 1.98 years. Manifest refraction, best-corrected visual acuity (BCVA), steepest meridian keratometry (K1), flattest meridian keratometry (K2), maximum keratometry (Kmax), thinnest corneal thickness (TCT), posterior central elevation (PCE), and posterior mean elevation (PME) were measured before and after ATE-CXL. The patients were followed-up at 1, 6, and 12 months. Repeated measures analysis of variance was used for statistical analysis.  P  < 0.05 was considered statistically significant.    Results  There were no complications in any case during or after ATE-CXL. BCVA improved from 0.64 ± 0.32 preoperatively to 0.69 ± 0.32 at 1-year postoperatively. The Kmax value was 56.67 ± 9.60 D before the treatment and 56.19 ± 8.55 D, 56.08 ± 8.85 D, and 55.94 ± 8.46 D at 1, 6, and 12 months postoperatively, respectively. No statistically significant differences were present in K1, K2, Kmax, PCE, and TCT before and after ATE-CXL during the 12-month follow-up ( P  > 0.05).    Conclusions  ATE-CXL is a safe and effective treatment in pediatric progressive keratoconus patients. The long-term effects need further observation.    Trial registration  Retrospectively registered. Registration number:  ChiCTR-OIC-16008181 . Registered 29 March 2016.

One-year follow-up of accelerated transepithelial corneal collagen cross-linking for progressive pediatric keratoconus