Comparison of Different Methods of Corneal Collagen Crosslinking: A Systematic Review

Abdelkader, Sidi Mohamed Hamida; Fernández, Joaquín; Rodríguez‐Vallejo, Manuel; Sánchez‐García, Alicia; Piñero, David P.

doi:10.1080/08820538.2021.1890784

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…14 In multicenter prospective clinical trials, CXL has demonstrated its ability to stop the progression of keratoconus and corneal ectasia after refractive surgery. 15 The initial CXL protocol has shown a high success rate and a low percentage of complications, although two main drawbacks were evident: the long surgical procedure time (>1 hour) and the need to remove the epithelium (more potential complications and long and unpleasant postoperative period for the patient). 15 Some variations of this protocol have appeared over the years to overcome these previous two limitations, including modifications in the duration of the treatment (standard vs accelerated), the light pattern used (continuous vs pulsed), the action against the corneal epithelium (Epi-OFF vs Epi-ON), and the use of an electric field (iontophoresis).…”

Section: Introductionmentioning

confidence: 99%

“…15 The initial CXL protocol has shown a high success rate and a low percentage of complications, although two main drawbacks were evident: the long surgical procedure time (>1 hour) and the need to remove the epithelium (more potential complications and long and unpleasant postoperative period for the patient). 15 Some variations of this protocol have appeared over the years to overcome these previous two limitations, including modifications in the duration of the treatment (standard vs accelerated), the light pattern used (continuous vs pulsed), the action against the corneal epithelium (Epi-OFF vs Epi-ON), and the use of an electric field (iontophoresis). 15 The aim of the current study was to evaluate the clinical outcomes obtained using Epi-ON CXL during 3 years of retrospective follow-up in eyes with primary and iatrogenic corneal ectasia.…”

Section: Introductionmentioning

confidence: 99%

“…15 Some variations of this protocol have appeared over the years to overcome these previous two limitations, including modifications in the duration of the treatment (standard vs accelerated), the light pattern used (continuous vs pulsed), the action against the corneal epithelium (Epi-OFF vs Epi-ON), and the use of an electric field (iontophoresis). 15 The aim of the current study was to evaluate the clinical outcomes obtained using Epi-ON CXL during 3 years of retrospective follow-up in eyes with primary and iatrogenic corneal ectasia.…”

Section: Introductionmentioning

confidence: 99%

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Long-term Analysis of Epi-ON Corneal Collagen Cross-linking Outcomes in Corneal Ectasia

Melián¹,

Rodríguez²,

Carreras³

et al. 2022

International Journal of Keratoconus and Ectatic Corneal Diseases

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Aim and objective: To evaluate the 3-year follow-up clinical outcomes obtained in corneal ectasia using Epi-ON corneal collagen cross-linking (CXL). Materials and methods:This study is a retrospective study enrolling 46 eyes from 32 patients with progressive corneal ectasia and treated with Epi-ON CXL in the period from September 2012 to April 2016. Two groups were differentiated according to the type of corneal ectasia: ectasia post-LASIK group (EPL, 12 eyes) and primary ectasia group (34 eyes). Two different platforms were used for the surgical protocol: VEGA CBM X LINKER platform (CSO, Firenze, Italy) and KXL (Avedro, Waltham, Massachusetts, USA). Visual, refractive, and corneal tomographic outcomes were evaluated during a 3-year follow-up. Results: A statistically significant improvement in the logMAR corrected distance visual acuity (CDVA) was observed in the whole sample (p <0.001) during the follow-up, with half of the sample improving one or more lines of CDVA. Likewise, only significant changes were detected in steepest keratometry (p <0.001), corneal astigmatism (p = 0.012), and index of height asymmetry (p = 0.021), with a trend to increase. Regarding the comparison between groups, more significant improvement in CDVA was found in the EPL group compared to the primary ectasia group (−0.07 ± 0.09 vs −0.15 ± 0.14, p = 0.028). Likewise, a significant trend to more corneal thinning was observed in primary ectasia group (p = 0.034). Conclusion:Epi-ON CXL is efficacious for stabilizing the progression of primary and iatrogenic ectasias for most cases, with significant improvement of visual acuity associated.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term Analysis of Epi-ON Corneal Collagen Cross-linking Outcomes in Corneal Ectasia

Melián¹,

Rodríguez²,

Carreras³

et al. 2022

International Journal of Keratoconus and Ectatic Corneal Diseases

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“…Wollensak et al [5] introduced the CXL treatment in 2003, which is being considered a standard, minimally invasive, and safe therapeutic option for progressive KC [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. e principle goal of CXL is to stabilize the progression of KC by increasing the mechanical stability of the cornea [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Likewise, a successful CXL can prevent the progression of KC and can even cause the ectatic cornea to regress, but also a non-effect or even worsening of the ocular parameters can occur [2].…”

Section: Introductionmentioning

confidence: 99%

“…The exact mechanism of KC development is not well understood, but it is commonly accepted that genetic susceptibility and environmental factors are necessary [ 2 ]. In addition, secondary ectasia may be caused by a purely mechanical process in a predisposed cornea and may be unilateral [ 4 ]. The factors associated with KC include positive family history, atopic constitution, eye rubbing, sleep apnea, a place of living, blood group, and genetic syndromes, such as Down, chromosome translocation, and chromosome ring abnormality [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Preliminary Characterization of Predictive Factors of the Visual Change after Epi-On and Epi-Off Corneal Collagen Crosslinking Techniques

Abdelkader

Fernández²,

Sebastián³

et al. 2021

Journal of Ophthalmology

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Purpose. To investigate the potential predictive factors of the visual change achieved with accelerated epi-on and epi-off corneal collagen crosslinking (CXL) in keratoconus. Methods. This retrospective comparative study analyzed 67 eyes treated with an accelerated epithelium-on (epi-on group) and epithelium-off (epi-off group) CXL. The clinical outcomes were evaluated and compared during a 1-year follow-up. Likewise, the relationship of the change achieved with both CXL techniques in the corrected distance visual acuity (CDVA) with different preoperative data was investigated. Results. The mean CDVA change at 3 months postoperatively was −0.04 ± 0.19 and −0.07 ± 0.25 in the epi-on and epi-off groups, respectively ( p = 0.809). In the epi-on group, this change was significantly correlated with the preoperative apical (r = −0.375, p = 0.045) and central corneal thickness (r = −0.402, p = 0.031). In the epi-off group, the CDVA change was significantly correlated with not only the preoperative apical (r = 0.402, p = 0.028) and central corneal thickness (r = 0.367, p = 0.046) but also with some topometric and aberrometric indices (r ≤ −0.374, p ≤ 0.042). Furthermore, the change in CDVA in the epi-on group could be predicted from age, preoperative refractive astigmatism J45 component, anterior corneal asphericity, and posterior corneal high order aberration root mean square ( p = 0.002, R2 = 0.503). In the epi-off group, the CDVA change could be predicted from the preoperative minimum corneal thickness and magnitude of the vertical anterior corneal primary coma component ( p = 0.001, R2 = 0.446). Conclusions. Clearly, different predictive factors of the visual change induced with the accelerated epi-on and epi-off CXL techniques are present, suggesting a different mechanism of action for stiffening the cornea and inducing changes in this structure.

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Epithelium-on versus epithelium-off corneal collagen crosslinking for keratoconus: a systematic review and meta-analysis

Borchert,

Kandel,

Watson

2023

Graefes Arch Clin Exp Ophthalmol

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Purpose Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to compare the efficacy and safety of epithelium-on versus epithelium-off CXL to treat keratoconus. Methods We searched PubMed, Medline, Embase, Web of Science, and Scopus databases. We included studies that compared standard epithelium-off with epithelium-on CXL. The primary outcome measures were changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax), and the secondary outcomes were uncorrected distance visual acuity (UDVA), central corneal thickness (CCT), and adverse events. A meta-analysis was performed on the primary and secondary outcomes based on the weighted mean differences between baseline to 12-month follow-up. Results The search retrieved 887 publications with 27 included in the systematic review. A total of 1622 eyes (1399 patients; age 25.51 ± 4.02 years) were included in comparisons of epithelium-off to epithelium-on CXL in keratoconus. Epithelium-off CXL treated 800 eyes and epithelium-on CXL for 822 eyes. At 12-month follow-up, CDVA and Kmax showed no significant difference between the epithelium-off and epithelium-on CXL. The secondary outcomes showed that UDVA was better in epithelium-off CXL (− 0.11D, 95% CI − 0.12, − 0.1; p < 0.001) and there was more thinning in CCT in epithelium-off CXL (− 3.23 μm, 95% CI − 4.64, − 1.81; p <0.001). Conclusion Epithelium-off and epithelium-on CXL were both effective to treat progressive keratoconus. Further research is needed to compare the long-term outcomes and safety of both CXL protocols for adaptation into clinical practice.

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Comparison of Different Methods of Corneal Collagen Crosslinking: A Systematic Review

Cited by 8 publications

References 22 publications

Long-term Analysis of Epi-ON Corneal Collagen Cross-linking Outcomes in Corneal Ectasia

Long-term Analysis of Epi-ON Corneal Collagen Cross-linking Outcomes in Corneal Ectasia

Preliminary Characterization of Predictive Factors of the Visual Change after Epi-On and Epi-Off Corneal Collagen Crosslinking Techniques

Epithelium-on versus epithelium-off corneal collagen crosslinking for keratoconus: a systematic review and meta-analysis

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