Related Experiment Video
Updated: Aug 30, 2026
Ye's Swing Technique for Small-incision Lenticule Extraction Surgery
Published on: June 27, 2025
Small-incision lenticule extraction with prophylactic crosslinking: systematic review and meta-analysis
Kareem Sadek1, Oreoluwapo Maxwell, Brendan K Tao
1From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (Sadek, Maxwell); Department of Ophthalmology & Vision Science, University of Toronto, Toronto, Ontario, Canada (Tao, Popovic, Chan); Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada (Hussein).
Topic:
Keratorefractive lenticule extraction (KLEx) treats myopia and myopic astigmatism while preserving corneal biomechanics better than flap-based procedures. KLEx with prophylactic accelerated corneal crosslinking (KLEx-CXL) has been proposed for thinner corneas, higher myopia, or borderline tomography, but its incremental value remains uncertain.
Clinical Relevance:
KLEx-CXL may reduce biomechanical instability but adds operative time, cost, and protocol variability. Comparative evidence is needed to determine whether it improves outcomes over KLEx alone.
Methods:
MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and CINAHL were searched to July 2, 2026. Comparative adult studies with at least 6-month follow-up reporting refractive or visual outcomes were included. 2 reviewers extracted data, assessed risk of bias, and rated certainty using Grading of Recommendations, Assessment, Development, and Evaluation. Random-effects meta-analyses pooled mean differences (MDs).
Results:
9 studies included 730 eyes: 386 KLEx and 344 KLEx-CXL. Residual manifest refraction spherical equivalent was similar overall (MD 0.03 diopters [D]; 95% CI, -0.01 to 0.06; P = .17), with no consistent timepoint-specific difference. A small residual difference was confined to moderate-myopia cohorts (0.09 D; 95% CI, 0.04-0.15) and absent in high myopia. KLEx showed a 1-month advantage in uncorrected distance vision (MD -0.04 logMAR), safety index (MD 0.07), and efficacy index (MD 0.08), resolving by 12 months. Corrected vision was similar throughout. Biomechanical measures favored KLEx-CXL. Early haze was transient; no ectasia occurred. Certainty was low.
Conclusions:
KLEx and KLEx-CXL achieved similar residual refraction and corrected visual acuity. KLEx-CXL produced measurable biomechanical reinforcement but transiently delayed early uncorrected visual recovery. Current evidence supports reserving prophylactic crosslinking for higher-risk eyes.
