Comparison of epithelium-off vs transepithelial corneal collagen cross-linking for keratoconus: a systematic review and meta-analysis

Session Details

Session Title: Cross-Linking Protocols

Session Date/Time: Monday 24/09/2018 | 14:00-16:00

Paper Time: 15:32

Venue: Room A3, Podium 3

First Author: : J.Huang CHINA

Co Author(s): :    B. Song   D. Wen   C. McAlinden   D. David O'Brart   Q. Wang        

Abstract Details

Purpose:

To systematically compare standard epithelium-off (SCXL) and transepithelial corneal collagen crosslinking (TECXL) for treating keratoconus.

Setting:

Eye Hospital, Wenzhou Medical University, Wenzhou, China.

Methods:

PubMed, Embase, the Cochrane Library, the US trial registry (ClinicalTrials.gov), VIP Database, Wanfang Databse and China National Knowledge Infrastructure (CNKI) were conducted up to February 2017. Primary outcomes were changes at 1 year in uncorrected distance visual acuity (UDVA), maximum keratometry (Kmax) and mean keratometry (mean K). Secondary outcomes were changes at 1 year in corrected distance visual acuity (CDVA), mean refractive spherical equivalent (MRSE), central corneal thickness (CCT) and endothelial cell density (ECD), and the occurrence of adverse events.

Results:

Eight studies with a total of 455 eyes were included. For primary outcomes, SCXL showed a greater reduction in mean K (SMD 0.28; 95% CI 0.03 to 0.53; p=0.03) compared to TECXL. Sub-group analysis indicated that SCXL had a comparable effect on reducing mean K with TECXL protocols using chemical enhancers (SMD 0.05; 95% CI -0.36 to 0.45; p=0.82) but a greater reduction in mean K compared to TECXL with current iontophoretic protocols (SMD 0.43; 95% CI 0.10 to 0.75; p=0.01). For the other outcomes, there were no statistically significant differences.

Conclusions:

With the exception of a reduction in mean K with current iontophoretic protocols, analysis of the limited number of comparative studies available appears to demonstrate that SCXL and TECXL have a comparable effect on visual, refractive, pachymetric and endothelial parameters 1 year following surgery. Further follow-up is required to determine whether these techniques are comparable in the long-term.

Financial Disclosure:

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