Abstract
ObjectiveTo evaluate the efficacy of corneal collagen cross-linking (CXL) for the treatment of keratoconus.MethodsWe performed a literature search for randomized controlled trials that assessed the effect of CXL in slowing progression of keratoconus. The primary outcome measures included changes of topographic parameters, visual acuity, and refraction. Efficacy estimates were evaluated by weighted mean difference (WMD) and 95% confidence interval (CI) for absolute changes of the interested outcomes.ResultsSignificant decrease in mean keratometry value, maximum keratometry value and minimum keratometry value were demonstrated in the CXL group compared with the control group (WMD = -1.65; 95% CI: -2.51 to -0.80; P < 0.00001; WMD = -2.05; 95% CI: -3.10 to -1.00; P < 0.00001; WMD = -1.94; 95% CI: -2.63 to -1.26; P < 0.00001; respectively). Best spectacle-corrected visual acuity improved significantly in CXL group (WMD = -0.10; 95% CI: -0.15 to -0.05; P < 0.00001), whereas uncorrected visual acuity did not differ statistically. Manifest cylinder error decreased significantly in patients undergoing CXL procedure compared with control patients in sensitivity analysis (WMD = -0.388; 95% CI: -0.757 to -0. 019; P = 0.04). The changes in central corneal thickness and intraocular pressure were not statistically significant.ConclusionCXL may be an effective option in stabilizing keratoconus. Further long-term follow-up studies will be necessary to assess the persistence of CXL.
Highlights
Keratoconus is the commonest corneal degenerative disorder characterized by para-central corneal thinning and secondary conical ectasia, resulting in irregular astigmatism and progressive myopia or visual loss [1]
Efficacy estimates were evaluated by weighted mean difference (WMD) and 95% confidence interval (CI) for absolute changes of the interested outcomes
Significant decrease in mean keratometry value, maximum keratometry value and minimum keratometry value were demonstrated in the CXL group compared with the control group (WMD = -1.65; 95% CI: -2.51 to -0.80; P < 0.00001; WMD = -2.05; 95% CI: -3.10 to -1.00; P < 0.00001; WMD = -1.94; 95% CI: -2.63 to -1.26; P < 0.00001; respectively)
Summary
Keratoconus is the commonest corneal degenerative disorder characterized by para-central corneal thinning and secondary conical ectasia, resulting in irregular astigmatism and progressive myopia or visual loss [1]. This novel technology with a combination of riboflavin (vitamin B2) eye drops to be absorbed throughout the cornea stroma and UV-A radiation which triggers photochemical reaction to change the cross links between and within collagen fibers may increase the biomechanical stiffness of the corneal stroma [6,7,8]. After that more and more non-randomized prospective and retrospective studies published the encouraging outcomes in advanced keratoconus throughout the world [9,10,11,12], including two meta-analysis which assessed the efficacy of CXL [13,14]. In order to provide powerful evidence for the widespread clinical practice of this new therapeutic method, we undertook this meta-analysis of all published RCTs to evaluate the effect of CXL in the treatment of keratoconus. This is the first study to pool the important outcome measures from RCTs of epitheliumoff CXL in keratoconus
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