Transepithelial Versus Epithelium-Off Corneal Crosslinking for Progressive Keratoconus: Findings From a Cochrane Systematic Review
| Autor: | Barbara S. Hawkins, Sueko M Ng, Irene Kuo |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Keratoconus
medicine.medical_specialty Visual acuity Corneal Pachymetry genetic structures Ultraviolet Rays Riboflavin Epithelium Article law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Ophthalmology medicine Humans Dioptre 030304 developmental biology 0303 health sciences Photosensitizing Agents Keratometer business.industry Data synthesis Corneal Topography Small sample medicine.disease eye diseases Confidence interval Cross-Linking Reagents Photochemotherapy 030221 ophthalmology & optometry Collagen medicine.symptom business |
| Zdroj: | Am J Ophthalmol |
| ISSN: | 0002-9394 |
| DOI: | 10.1016/j.ajo.2021.05.009 |
| Popis: | Purpose The purpose of this study was to summarize key findings from a systematic review of the effectiveness and safety of transepithelial corneal crosslinking (CXL) compared with epithelium-off CXL for progressive keratoconus. Design Cochrane systematic review. Methods We included in our review only randomized controlled trials (RCTs) in which transepithelial and epithelium-off CXL had been compared among participants with progressive keratoconus. The primary outcome was keratoconus stabilization based on post-operative maximum keratometry (Kmax). We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis. Results Thirteen RCTs with 567 participants (661 eyes) were included; 11 studies compared non-iontophoresis-assisted transepithelial with epithelium-off CXL. Keratoconus stabilization was described as an outcome in 2 studies. The estimated difference in Kmax means (ie, the “mean difference,” MD) from meta-analysis of 177 eyes in 5 RCTs indicated that there were no differences between intervention groups in Kmax at 12 months or later (MD: 0.99 diopter [D]; 95% confidence interval: −0.11 to 2.09). Meta-analysis of keratometry and visual acuity outcomes at 12 months or longer after surgery from 2 studies that had compared transepithelial CXL using iontophoresis provided no conclusive evidence of an advantage over epithelium-off CXL. Conclusions Lack of precision due to small sample sizes, indeterminate risk of bias due to inadequate reporting, and inconsistency in how outcomes were measured and reported among studies make it difficult to state with confidence whether transepithelial CXL confers an advantage over epithelium-off CXL for patients with progressive keratoconus with respect to stabilization of keratoconus, visual acuity, or patient-reported outcomes based on available data. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect