Efficacy of Corneal Collagen Cross-Linking for the Treatment of Keratoconus

Meiri, Zohar; Keren, Shay; Rosenblatt, Amir; Sarig, Tal; Shenhav, Liat; Varssano, David

doi:10.1097/ico.0000000000000723

Cited by 94 publications

(70 citation statements)

References 71 publications

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“…A recent meta‐analysis has reported that eyes treated with the Dresden protocol exhibit a K MAX reduction of 0.76 D at 1 year and 1.22 D at 2 years . In the current study, patients treated with the c‐ACXL protocol exhibited a larger reduction in K MAX reduction compared to patients treated with p‐ACXL at 2 years.…”

Section: Discussionsupporting

confidence: 47%

“…19 A recent meta-analysis has reported that eyes treated with the Dresden protocol exhibit a K MAX reduction of 0.76 D at 1 year and 1.22 D at 2 years. 20 In the current study, patients treated with the c-ACXL protocol exhibited a larger reduction in K MAX reduction compared to patients treated with p-ACXL at 2 years. This is in contrast to a previous report indicating that a larger reduction in K MAX is achieved 12 months after p-ACXL when compared to c-ACXL.…”

Section: Discussionmentioning

confidence: 48%

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Prospective two‐year study of clinical outcomes following epithelium‐off pulsed versus continuous accelerated corneal crosslinking for keratoconus

Ziaei

Gokul

Vellara

et al. 2019

Clinical Exper Ophthalmology

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Importance Keratoconus is a debilitating condition with a disproportionately high impact on health resources and vision‐specific quality of life. Background This study aimed to compare 2‐year outcomes of epithelium‐off pulsed (p‐ACXL) and epithelium‐off continuous (c‐ACXL) accelerated corneal crosslinking in progressive keratoconus. Design Prospective, interventional case series. Participants Eighty eyes of 80 patients were included. Methods The visual, refractive and tomographic results of the two crosslinking protocols were compared. Main Outcome Measures Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE) and maximum keratometry (KMAX) on corneal tomography assessment. Results The mean patient age was 22.51 ± 6.12 years (SD) and 22.08 ± 5.72 years in the p‐ACXL and c‐ACXL groups, respectively. The mean CDVA significantly improved from 0.30 ± 0.16 logMAR at baseline to 0.23 ± 0.17 logMAR at 24 months (P = .04) in the p‐ACXL group and from 0.36 ± 0.22 logMAR to 0.26 ± 0.27 logMAR (P = .02) in the c‐ACXL group. The mean induced change in MRSE (+1.79 ± 2.30 D vs +0.27 ± 3.19 D, P = .04) and KMAX (−1.75 ± 1.80 D vs −0.39 ± 1.95 D, P = .04) were superior in the c‐ACXL group compared to the p‐ACXL group at 24 months. No complications were encountered. Conclusions and Relevance In this prospective study, both p‐ACXL and c‐ACXL treatments were safe methods to halt the progression of keratoconus within a follow‐up period of 24 months. c‐ACXL appeared to offer superior refractive and tomographic outcomes when compared to p‐ACXL but this did not translate into better visual outcomes.

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 48%

Prospective two‐year study of clinical outcomes following epithelium‐off pulsed versus continuous accelerated corneal crosslinking for keratoconus

Ziaei

Gokul

Vellara

et al. 2019

Clinical Exper Ophthalmology

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“…By including two RCTs published in 2015, we could represent more updated evidence. The meta-analysis by Meiri et al [13] in 2016 included population-based prospective and retrospective studies. They did not focus their analysis on RCTs, which could provide the best evidence regarding the efficacy of CXL for a clinical condition.…”

Section: Discussionmentioning

confidence: 99%

“…However, their Cochrane review was unable to conduct a quantitative synthesis of the evidence because of the small number of RCTs. The two other meta-analyses included comparative and retrospective studies, which may lack evidence [12, 13]. Our hypothesis is that CXL may be effective in halting the progression of keratoconus for long-term follow-ups.…”

Section: Introductionmentioning

confidence: 99%

Corneal Collagen Cross-Linking for Keratoconus: Systematic Review

Kobashi

Rong

2017

BioMed Research International

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Purpose To evaluate the efficacy of collagen cross-linking (CXL) one year after treatment for keratoconus compared to no treatment by summarizing randomized controlled trials (RCTs) using a systematic review. Methods Trials meeting the selection criteria were quality appraised, and the data were extracted by two independent authors. The outcome parameters included maximum keratometry (Kmax), corneal thickness at the thinnest point, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), spherical equivalent (SE) refraction, and cylindrical refraction one year after CXL. We compared the changes in the above parameters with the control group. Results We identified five RCTs involving 289 eyes that met the eligibility criteria for this systematic review. The changes in BSCVA from baseline to one year exhibited a significant difference between the two groups. There was no statistically significant difference between the two groups for changes in corneal thickness and cylindrical refraction. We did not conduct a meta-analysis in Kmax, UCVA, and SE refraction because their I2 values were greater than 50%. Conclusions According to the systematic review, CXL may be effective in halting the progression of keratoconus for one year under certain conditions, although evidence is limited due to the significant heterogeneity and paucity of RCTs.

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“…Jordan et al . in prospective in vivo confocal microscopy study of corneal microstructural changes after crosslinking for keratoconus, showed the complete absence of stromal keratocyte nuclei in 86% of corneas at 1 month, while anterior stromal edema with hyper-reflective cytoplasm and extracellular lacunae in a honeycomb-like appearance may persist at 3 months postoperatively [21, 22]. These anterior stromal changes were also more pronounced in accelerated crosslinking compared to conventional crosslinking [23].…”

Section: Discussionmentioning

confidence: 99%

Conventional Versus Accelerated Collagen Cross-Linking for Keratoconus: A Comparison of Visual, Refractive, Topographic and Biomechanical Outcomes

Woo¹,

Iyer²,

Lim

et al. 2017

TOOPHTJ

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Objective:The aim was to compare the visual, refractive, topographic and biomechanical outcomes in patients with progressive keratoconus treated with either conventional or accelerated crosslinking at one year follow up.Methods:It is a prospective, non-randomised interventional study of 76 patients who underwent conventional (CXL; 3mW/cm2 for 30 minutes) or accelerated cross linking (KXL; 30mW/cm2 for 4 minutes) for progressive keratoconus. Baseline and postoperative visual acuity, manifest refraction, corneal topography, pachymetry, endothelial cell density and biomechanical parameters of corneal hysteresis and corneal resistance factor were evaluated and compared.Results:The 2 groups were comparable in terms of uncorrected and best corrected visual acuity and spherical equivalent. Both groups showed no significant increase in K1, K2 and Kmean from baseline at 12 months. There was also no difference between the CXL and KXL group for postoperative corneal topography as well as central and minimal pachymetry up to 12 months. There was a significant increase in both corneal hysteresis (0.62mm Hg, P=0.04) and corneal resistance factor (0.91mm Hg, P=0.003) in the KXL group at 12 months but not in the CXL group. There was no significant endothelial cell loss throughout follow up in both the groups.Conclusion:We have established comparability of the 2 protocols in stabilizing the progression of keratoconus. Our findings also suggested an added biomechanical advantage of accelerated crosslinking at 1 year follow up.

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Efficacy of Corneal Collagen Cross-Linking for the Treatment of Keratoconus

Abstract: CXL is a safe and effective method for halting the deterioration of KCN, while slightly improving visual function.

Cited by 94 publications

References 71 publications

Prospective two‐year study of clinical outcomes following epithelium‐off pulsed versus continuous accelerated corneal crosslinking for keratoconus

Prospective two‐year study of clinical outcomes following epithelium‐off pulsed versus continuous accelerated corneal crosslinking for keratoconus

Corneal Collagen Cross-Linking for Keratoconus: Systematic Review

Conventional Versus Accelerated Collagen Cross-Linking for Keratoconus: A Comparison of Visual, Refractive, Topographic and Biomechanical Outcomes

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