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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
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Transepithelial Versus Epithelium-Off Corneal Crosslinking for Progressive Keratoconus: Findings From a Cochrane
Sueko M Ng1, Barbara S Hawkins2, Irene C Kuo2
1From the Department of Ophthalmology (S.M.N.), School of Medicine, University of Colorado, Aurora, Colorado, USA.
American Journal of Ophthalmology
|May 28, 2021
Summary
Transepithelial corneal crosslinking (CXL) shows no clear advantage over epithelium-off CXL for progressive keratoconus stabilization. More research is needed due to small sample sizes and reporting inconsistencies in current studies.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Vision Science
Background:
- Progressive keratoconus is a degenerative eye condition.
- Corneal crosslinking (CXL) aims to halt keratoconus progression.
- Two main CXL methods exist: transepithelial (TE-CXL) and epithelium-off (EO-CXL).
Purpose of the Study:
- To systematically review and summarize evidence comparing the effectiveness and safety of TE-CXL versus EO-CXL for progressive keratoconus.
- To assess the impact of CXL on keratoconus stabilization and patient outcomes.
Main Methods:
- A Cochrane systematic review methodology was employed.
- Included only randomized controlled trials (RCTs) comparing TE-CXL and EO-CXL.
- Primary outcome: keratoconus stabilization via maximum keratometry (Kmax).
Main Results:
- Thirteen RCTs with 567 participants were analyzed.
- Meta-analysis of 5 RCTs (177 eyes) found no significant difference in Kmax at 12 months (MD: 0.99 D).
- Limited evidence suggests no conclusive advantage for iontophoresis-assisted TE-CXL over EO-CXL.
Conclusions:
- Current evidence is limited by small sample sizes and inconsistent reporting.
- It is difficult to definitively conclude if TE-CXL offers an advantage over EO-CXL for keratoconus stabilization.
- Further high-quality research is required to clarify the comparative efficacy and safety of these CXL techniques.
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