Assessment of postoperative corneal healing after epithelium‐off cross‐linking with a regenerating agent in progressive keratoconus patients

Abstract

PurposeTo evaluate and compare data on corneal healing from randomised clinical trials (RCTs) in adult patients with progressive keratoconus undergoing epithelium‐off corneal collagen cross‐linking (epi‐off CXL) and receiving a regenerating agent (RGTA).MethodsAn individual study review and a meta‐analysis were performed by searching RCTs assessing the effect of RGTA (Cacicol®) postoperatively used for keratoconus. We focused on the outcome related to corneal healing and epithelial defect size measured by slit lamp/photography with fluorescein staining or optical coherence tomography. Other endpoints related to symptoms included ocular pain, burning, stinging, tearing, photophobia, conjunctival hyperaemia, and postooperative consumption of analgesics.ResultsThree RCTs were identified for the meta‐analysis including 118 patients (136 eyes) in total. The individual review showed faster reepithelialisation after instillations of RGTA compared to standard postoperative treatment (respectively, 83.3 vs. 13.3% of patients healed at day 2 postoperatively, p < 0.001), to artificial tears (61.1 vs. 11.1% at day 3, p = 0.002) and to hyaluronic acid (4.4 ± 1.3 vs. 6.1 ± 2.3 days for complete healing, p = 0.008). The meta‐analysis showed that instantaneous chances of achieving complete healing over time were with RGTA twice as high as with control (Hazard ratio: 2.01; 95% confidence interval: [1.64; 2.47]; p < 0.001). The overall safety profile of RGTA was found to be satisfactory.ConclusionsInstillation of RGTA facilitates corneal epithelial healing after epi‐off CXL in patients with progressive keratoconus.