Comparison of Standard Versus Accelerated Corneal Collagen Cross-Linking for Keratoconus: A Meta-Analysis

Wen, Daizong; Li, Qi; Song, Benhao; Tu, Ruixue; Wang, Qinmei; O’Brart, David; McAlinden, Colm; Huang, Jinhai

doi:10.1167/iovs.18-24656

Cited by 63 publications

(62 citation statements)

References 84 publications

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“…Regarding the corneal thickness changes at the thinnest location, our outcomes are close to other published results 11,19,31–33. We recorded a reduction in pachymetry by 17.06 µm at the end of 5 years with an insignificant difference from the last 3 follow-up years values.…”

Section: Discussionsupporting

confidence: 90%

“…This may signify that the corneal surface becomes more regular following SCXL. Many authors documented similar findings 11,20. Furthermore, our results showed statistically significant improvement in the corneal asphericity (Q value) which is a good quantified indicator of asphericity of the corneal surface and could be considered as a clue of the optical and visual improvement.…”

Section: Discussionsupporting

confidence: 86%

“…In comparison with other CXL protocols, SCXL has greater improvements in KC indices 9. Despite the superiority of SCXL in comparison with transepithelial CXL in halting KC progression,10,11 the combination procedures; sometimes called cross-linking plus (CXL Plus);12,13 have become popular procedures that include combination of CXL with a refractive procedure such as wavefront-guided photorefractive keratectomy (WFG PRK),14 refractive lens surgery (RLS)15 and intracorneal ring segments (ICRS) to correct the refractive status of the ectatic eyes 12,16…”

Section: Introductionmentioning

confidence: 99%

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<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

Iqbal¹,

Elmassry²,

Badawi³

et al. 2019

OPTH

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PurposeTo analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management.Patients and methodsThis study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively.ResultsForty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by <1 D, 23 eyes (46.9%) improved from 1 D to <2 D and 7 eyes (14.3%) improved by ≥2 D. Both uncorrected distant visual acuity (UDVA) and corrected distant visual acuity (CDVA) showed statistically significant improvement from preoperative 1.34±0.29 (mean±SD) and 0.74±0.23 LogMAR to postoperative 0.99±0.32 and 0.50±0.22 LogMAR (P<0.0001) respectively. Both Kmax and SE refraction showed statistically significant and stable improvement from preoperative 51.95±1.90 and −7.90±3.14 D to postoperative 50.19±1.96 and −6.35±2.49 D (P<0.0001) respectively. Two eyes (4%) showed KC progression at the end of 5th follow-up year.ConclusionSCXL had good effectiveness and stability that halted KC progression over 5-year follow-up period. It had also unexpected improvement in the KC refractive components mainly the spherical and SE components.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

Iqbal¹,

Elmassry²,

Badawi³

et al. 2019

OPTH

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“…These results are similar to those in Kobashi and Tsubota study, which focused on adult population and showed that ACXL has less effect on improving corrected visual acuity than SCXL after 1-year follow-up. 33 Kmax in SCXL was also signi cant lower than those in A-TCXL group (Fig. 7A).…”

Section: Discussionmentioning

confidence: 83%

“…Previously it was reported that for adult patients with keratoconus, transepithelial CXL provided a more protective in uence on corneal thickness than standard CXL. 32 Early meta-analysis showed that accelerated CXL might lead to a less reduction in CCT than standard CXL, 33,34 but recent studies suggests no difference between the ACXL and SCXL when comparing the CCT. 35,36 In pediatric population, our meta-analysis also observed no statistical difference in CCT among different CXL protocols, regardless of different follow-up time (Fig.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Comparison of Standard Versus Accelerated Epithelium-Off and Transepithelial Corneal Cross-Linking in Pediatric Keratoconus: An Up-to-date Meta-Analysis

Yin

et al. 2020

Preprint

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Purpose: To compare the efficacy of four corneal cross-linking (CXL) protocols: standard epithelium-off (SCXL), accelerated epithelium-off (ACXL), transepithelial (TCXL), and accelerated transepithelial (A-TCXL) for pediatric keratoconus.Methods:A comprehensive literature search on the efficacy of SCXL, ACXL, TCXL and A-TCXL in treating keratoconus patients age 18-year or under was conducted using PubMed and EMBASE up to March 2020. Primary outcomes included uncorrected visual acuity (UCVA) and maximum keratometry (Kmax). Secondary outcomes included best-corrected visual acuity (BCVA), central corneal thickness (CCT), and mean refractive spherical equivalent (MRSE). Estimations were analyzed by weighted mean difference (WMD) and 95% confidence interval (95% CI) for the outcomes during observation periods from 6 to 36 months.Results:Eight papers involving total 704 eyes were enrolled. In pediatrics, ACXL resulted in significantly better postoperative UCVA than SCXL at 12-month observation (WMD = 0.08, 95% CI: 0.02 to 0.14, P = 0.007), while SCXL provided statistically better BCVA (WMD = -0.07, 95% CI: -0.12 to -0.01, P = 0.01) and MRSE (WMD = 0.31, 95% CI: 0.06 to 0.56, P = 0.01) than ACXL at 24 months. Furthermore, SCXL provided significantly improved BCVA compared with TCXL at 12- to 24-month observation. (WMD = -0.13, 95% CI: -0.21 to -0.05, P = 0.001). Conclusions:In pediatric keratoconus, although UCVA in short-term follow-up after ACXL was better than that after SCXL, the long-run results showed that SCXL may provide superior visual acuity than either ACXL or TCXL. Further investigation is required to compare the efficacy of different CXL protocols for the management of pediatric keratoconus.

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Engineering Hibiscus‐Like Riboflavin/ZIF‐8 Microsphere Composites to Enhance Transepithelial Corneal Cross‐Linking

Mei

Chen

et al. 2022

Advanced Materials

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Riboflavin‐5‐phosphate (RF) is the most commonly used photosensitizer in corneal cross‐linking (CXL), but its hydrophilicity and negative charge limit its penetration through the corneal epithelium into the stroma. To enhance the corneal permeability of RF and promote its efficacy in the treatment of keratoconus, novel hibiscus‐like RF@ZIF‐8 microsphere composites [6RF@ZIF‐8 NF (nanoflake)] are prepared using ZIF‐8 nanomaterials as carriers, which are characterized by their hydrophobicity, positive potential, biocompatibility, high loading capacities, and large surface areas. Both hematoxylin and eosin endothelial staining and TUNEL assays demonstrate excellent biocompatibility of 6RF@ZIF‐8 NF. In in vivo studies, the 6RF@ZIF‐8 NF displayed excellent corneal permeation, and outstanding transepithelial CXL (TE‐CXL) efficacy, slightly better than the conventional CXL protocol. Furthermore, the special hibiscus‐like structures of 6RF@ZIF‐8 NF meant that it has better TE‐CXL efficacy than that of 6RF@ZIF‐8 NP (nanoparticles) due to the larger contact area with the epithelium and the shorter RF release passage. These results suggest that the 6RF@ZIF‐8 NF are promising for transepithelial corneal cross‐linking, avoiding the need for epithelial debridement.

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Comparison of Standard Versus Accelerated Corneal Collagen Cross-Linking for Keratoconus: A Meta-Analysis

Abstract: SCXL has a greater effect in terms of reduction in Kmax than ACXL, while ACXL induces less reduction in CCT and ECD than SCXL. Further well-designed randomized controlled trials comparing ACXL and SCXL are indicated.

Cited by 63 publications

References 84 publications

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

WITHDRAWN: Comparison of Standard Versus Accelerated Epithelium-Off and Transepithelial Corneal Cross-Linking in Pediatric Keratoconus: An Up-to-date Meta-Analysis

Engineering Hibiscus‐Like Riboflavin/ZIF‐8 Microsphere Composites to Enhance Transepithelial Corneal Cross‐Linking

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