Accelerated Versus Conventional Corneal Collagen Cross-Linking in the Treatment of Keratoconus: A Meta-analysis and Review of the Literature

Jiang, Yang; Yang, Shan; Liu, Ying; Cui, Ge; Lu, Thomas Chengxuan

doi:10.1007/s12539-019-00336-9

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…32 Early meta-analysis showed that accelerated CXL might lead to a less reduction in CCT than standard CXL, 33,34 but recent studies suggests no difference between the ACXL and SCXL when comparing the CCT. 35,36 In pediatric population, our meta-analysis also observed no statistical difference in CCT among different CXL protocols, regardless of different follow-up time (Fig. 4B, Fig.…”

Section: Discussionmentioning

confidence: 60%

WITHDRAWN: Comparison of Standard Versus Accelerated Epithelium-Off and Transepithelial Corneal Cross-Linking in Pediatric Keratoconus: An Up-to-date Meta-Analysis

Yin

et al. 2020

Preprint

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Purpose: To compare the efficacy of four corneal cross-linking (CXL) protocols: standard epithelium-off (SCXL), accelerated epithelium-off (ACXL), transepithelial (TCXL), and accelerated transepithelial (A-TCXL) for pediatric keratoconus.Methods:A comprehensive literature search on the efficacy of SCXL, ACXL, TCXL and A-TCXL in treating keratoconus patients age 18-year or under was conducted using PubMed and EMBASE up to March 2020. Primary outcomes included uncorrected visual acuity (UCVA) and maximum keratometry (Kmax). Secondary outcomes included best-corrected visual acuity (BCVA), central corneal thickness (CCT), and mean refractive spherical equivalent (MRSE). Estimations were analyzed by weighted mean difference (WMD) and 95% confidence interval (95% CI) for the outcomes during observation periods from 6 to 36 months.Results:Eight papers involving total 704 eyes were enrolled. In pediatrics, ACXL resulted in significantly better postoperative UCVA than SCXL at 12-month observation (WMD = 0.08, 95% CI: 0.02 to 0.14, P = 0.007), while SCXL provided statistically better BCVA (WMD = -0.07, 95% CI: -0.12 to -0.01, P = 0.01) and MRSE (WMD = 0.31, 95% CI: 0.06 to 0.56, P = 0.01) than ACXL at 24 months. Furthermore, SCXL provided significantly improved BCVA compared with TCXL at 12- to 24-month observation. (WMD = -0.13, 95% CI: -0.21 to -0.05, P = 0.001). Conclusions:In pediatric keratoconus, although UCVA in short-term follow-up after ACXL was better than that after SCXL, the long-run results showed that SCXL may provide superior visual acuity than either ACXL or TCXL. Further investigation is required to compare the efficacy of different CXL protocols for the management of pediatric keratoconus.

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Section: Discussionmentioning

confidence: 60%

WITHDRAWN: Comparison of Standard Versus Accelerated Epithelium-Off and Transepithelial Corneal Cross-Linking in Pediatric Keratoconus: An Up-to-date Meta-Analysis

Yin

et al. 2020

Preprint

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“…2018a,b; Jiang et al. 2019), refractive surgeries (Allard & Zetterberg 2018; Benoist d’Azy et al. 2019) or corneal graft (Dragnea et al.…”

Section: Introductionmentioning

confidence: 99%

Oxidative and antioxidative stress markers in keratoconus: a systematic review and meta‐analysis

Navel

Malecaze

Pereira

et al. 2020

Acta Ophthalmologica

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Purpose To conduct a systematic review and meta‐analysis on the levels of oxidative stress markers and antioxidants in keratoconus compared to healthy subject. Method The PubMed, Cochrane Library, Embase, Science Direct and Google Scholar databases were searched on 1st June 2020 for studies reporting oxidative and antioxidative stress markers in keratoconus and healthy controls. Main meta‐analysis was stratified by type of biomarkers, type of samples (tears, cornea, aqueous humour and blood) and type of corneal samples (stromal cells, epithelium and endothelium). Results We included 36 articles, for a total of 1328 keratoconus patients and 1208 healthy controls. There is an overall increase in oxidative stress markers in keratoconus compared with healthy controls (standard mean deviation (SMD) = 0.94, 95% confidence interval (95% CI) 0.55–1.33), with a significant increase in reactive oxygen and nitrogen species (1.09, 0.41–1.78) and malondialdehyde (1.78, 0.83–2.73). There is an overall decrease in antioxidants in keratoconus compared with healthy controls (−0.63, −0.89 to −0.36), with a significant decrease in total antioxidant capacity/status (−1.65, −2.88 to −0.43), aldehyde/NADPH dehydrogenase (−0.77, −1.38 to −0.17), lactoferrin/transferrin/albumin (−1.92, −2.96 to −0.89) and selenium/zinc (−1.42, −2.23 to −0.61). Oxidative stress markers were higher in tears and in cornea of keratoconus than in aqueous humour, and antioxidants were decreased in tears, aqueous humour and blood without difference between sample type. Oxidative stress markers increased in stromal cells and antioxidants decreased in endothelium. Conclusion Oxidative stress markers and antioxidants were dysregulated in keratoconus, involving an imbalance of redox homeostasis in tears, cornea, aqueous humour and blood.

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“…On the other hand, epi-off directly severs nociceptors in the plexus in addition to the photochemical damage. Accelerated versions of epi-off and epi-on CXL use higher intensity UV light and riboflavin concentrations, which save time while producing similar results 45 46. These accelerated versions do seem to result in greater pain levels, presumably due to the higher impact of the procedure to the cornea (table 2, figure 1).…”

Section: Discussionmentioning

confidence: 95%

Pain mechanisms and management in corneal cross-linking: a review

et al. 2021

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Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-on technique (epi-on) associated with less postsurgical pain than the gold standard, epithelial-off technique (epi-off). After the first few days, however, the difference in pain scores and need for analgesics between epi-on and epi-off disappear. Patients experience relatively high-intensity pain the first few days post-CXL, and many strategies for acute pain control following CXL have been studied. Currently, no method of pain management is considered superior or universally accepted. Acute pain following CXL is a recognised and clinically significant side effect, but few CXL studies have systematically investigated postoperative pain and its management. This review aims to improve patient pain outcomes following this increasingly common procedure.

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Accelerated Versus Conventional Corneal Collagen Cross-Linking in the Treatment of Keratoconus: A Meta-analysis and Review of the Literature

Cited by 7 publications

References 24 publications

WITHDRAWN: Comparison of Standard Versus Accelerated Epithelium-Off and Transepithelial Corneal Cross-Linking in Pediatric Keratoconus: An Up-to-date Meta-Analysis

WITHDRAWN: Comparison of Standard Versus Accelerated Epithelium-Off and Transepithelial Corneal Cross-Linking in Pediatric Keratoconus: An Up-to-date Meta-Analysis

Oxidative and antioxidative stress markers in keratoconus: a systematic review and meta‐analysis

Pain mechanisms and management in corneal cross-linking: a review

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