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Published on: November 22, 2024
Transepithelial versus epithelium-off corneal crosslinking for corneal ectasia
Hidenaga Kobashi1, Shi Song Rong1, Joseph B Ciolino1
1From the Schepens Eye Research Institute (Kobashi), Department of Ophthalmology, Harvard Medical School, Boston, and the Massachusetts Eye and Ear Infirmary (Rong, Ciolino), Harvard Medical School, Boston, Massachusetts, USA the Department of Ophthalmology (Kobashi), Keio University, School of Medicine, Tokyo, Japan.
Abstract:
This review compared the clinical results of transepithelial corneal crosslinking (CXL) to epithelium-off (epi-off) CXL in progressive corneal ectasia using a metaanalysis. The Cochrane databases and Medline were searched for randomized controlled trials (RCTs). Seven RCTs involving 505 eyes that met the eligibility criteria were identified. The epi-off CXL group showed significantly better outcomes in postoperative changes in maximum keratometry (K) during 1-year observation periods. Transepithelial CXL resulted in significantly greater post-treatment central corneal thickness and best spectacle-corrected visual acuity (BSCVA). The presence of a postoperative demarcation line was significantly more frequent after epi-off CXL than that after transepithelial CXL. No statistically significant difference was found between other parameters. Although patients in the transepithelial CXL group demonstrated a greater improvement in BSCVA compared with patients in the epi-off CXL group at the 1 year follow-up, transepithelial CXL had less impact on halting progressive corneal ectasia in terms of maximum K than epi-off CXL.
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