Corneal collagen cross-linking in keratoconus: A systematic review and meta-analysis

Tian, Cheng; Peng, Xueping; Fan, Zhengjun; Xia, Zhengyuan; Zhou, Feihu

doi:10.1038/srep05652

Cited by 52 publications

(41 citation statements)

References 39 publications

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“…These findings are similar to those in the meta‐analysis by Chunyu et al. Central corneal thickness also remained stable at 1 year in both treatment protocols. Interestingly, there was a significant increase in CCT at 2 years in the standard group; however, the sample size was small.…”

Section: Discussionsupporting

confidence: 89%

“…Chunyu et al. () also noted a less significant effect on UCVA and postulate that this is secondary to advancing myopia seen in keratoconus as described by Goldich et al. .…”

Section: Discussionmentioning

confidence: 87%

“…A systematic review by Chunyu et al. () published in 2014 and which performed a meta‐analysis of 23 papers ( n = 1557 eyes), without distinction as to age found similar large effects of CXL on visual acuity. At 1 year, the BCVA results were (SMD 0.81; 95% CI 0.43–1.18; p < 0.01) and this remained significant after 18 months.…”

Section: Discussionmentioning

confidence: 91%

“…In their meta‐analysis, Chunyu et al. found a significant improvement in Kmax at 1 year (SMD 0.05; 95% CI 0.02–0,28; p = 0.03) and this was maintained at >18 months follow‐up. In their RCT of standard CXL, Wittig‐Silva et al.…”

Section: Discussionmentioning

confidence: 95%

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Cross‐linking in children with keratoconus: a systematic review and meta‐analysis

McAnena

Doyle

O’Keefe

2016

Acta Ophthalmologica

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Keratoconus can behave more aggressively in pediatric than in adult patients. We systematically reviewed the literature to determine the effectiveness of corneal collagen cross‐linking (CXL) in children. For this study, MEDLINE® and Cochrane databases were searched for all studies examining the effects of standard, trans‐epithelial or accelerated CXL protocols in patients age 18 years or younger. Primary outcomes were; uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) and secondary outcomes were; best‐corrected visual acuity (BCVA), mean refractive spherical equivalent (MRSE), central corneal thickness (CCT) and endothelial cell density (ECD). Standardized mean differences (SMD) and 95% confidence intervals were calculated, comparing baseline values with those at 6, 12 and 24 months. A total of 13 papers, published between May 2011 and December 2014 examining 490 eyes of 401 patients with a mean age of 15.25 (±1.5) years, were included in the qualitative analysis in this review. Nine papers were included in the meta‐analysis, showing significant improvement in UCVA and BCVA and stable Kmax at 12 months, and stable UCVA, improved BCVA and improved Kmax at 24 months in the standard protocol group UCVA, BCVA and KMax were stable at 12 months in the trans‐epithelial group. Mean refractive spherical equivalent (MRSE), CCT and ECD remained stable in both groups. In conclusion it was found that standard CXL may be effective in halting progression of keratoconus in pediatric patients at 1 year. However, larger, more long‐term studies are required to ascertain its effectiveness.

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Section: Discussionsupporting

confidence: 89%

“…Chunyu et al. () also noted a less significant effect on UCVA and postulate that this is secondary to advancing myopia seen in keratoconus as described by Goldich et al. .…”

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 95%

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Cross‐linking in children with keratoconus: a systematic review and meta‐analysis

McAnena

Doyle

O’Keefe

2016

Acta Ophthalmologica

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“…Similar results were reported by Poli et al in their 3-year prospective study of CXL [21]. In addition, a systematic review and meta-analysis which included 1171 participants with 1557 affected eyes found a slight decrease in CCT from baseline to 12 months post-CXL and then recovered to baseline after more than 18 months [22]. Perhaps the reason is the follow-up period was too short to be observed.…”

Section: Discussionsupporting

confidence: 74%

Thinner Corneas Appear to Have More Striking Effects of Corneal Collagen Crosslinking in Patients with Progressive Keratoconus

Han

Zhu

et al. 2017

Journal of Ophthalmology

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Purpose. To analyze the outcomes and difference after UVA/riboflavin corneal collagen crosslinking (CXL) in four different corneal thickness groups of patients with progressive keratoconus. Methods. Retrospective study. Eyes with progressive keratoconus after CXL were divided into 4 subgroups as follows: group 1, thinnest corneal thickness (TCT) ≤ 400 µm; group 2, 400 µm < TCT ≤ 450 µm; group 3, 450 µm < TCT ≤ 500 µm; group 4, TCT ≥ 500 µm. Baseline, 6-month, and 12-month visual acuity, corneal topography, TCT, and endothelial cell density were evaluated. Results. The analysis included 123 eyes of 101 patients. At 6 and 12 months after CXL, there was a mean improvement about visual acuity and keratometry values in all patients. There was a reduction in the change of maximum keratometry (Kmax) with the increase of TCT. After 1 year of treatment, it was 3.04 ± 0.75 D in group 1, 2.38 ± 0.51 D in group 2, 1.57 ± 0.35 D in group 3, and 0.31 ± 0.20 D in group 4. Conclusion. CXL is successful in halting the progression of keratoconus and there was a negative linear correlation between TCT and Kmax. Advanced cases of progressive keratoconus seemed to obtain more benefits from the flatting effects of CXL.

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Reliability of the Evidence Addressing Treatment of Corneal Diseases

et al. 2019

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IMPORTANCE Patient care should be informed by clinical practice guidelines, which in turn should be informed by evidence from reliable systematic reviews. The American Academy of Ophthalmology is updating its Preferred Practice Patterns (PPPs) for the management of the following 6 corneal diseases: bacterial keratitis, blepharitis, conjunctivitis, corneal ectasia, corneal edema and opacification, and dry eye syndrome. OBJECTIVE To summarize the reliability of the existing systematic reviews addressing interventions for corneal diseases. DATA SOURCE The Cochrane Eyes and Vision US Satellite database. STUDY SELECTION In this study of published systematic reviews from 1997 to 2017 (median, 2014), the Cochrane Eyes and Vision US Satellite database was searched for systematic reviews evaluating interventions for the management of any corneal disease, combining eyes and vision keywords and controlled vocabulary terms with a validated search filter. DATA EXTRACTION AND SYNTHESIS The study classified systematic reviews as reliable when each of the following 5 criteria were met: the systematic review specified eligibility criteria for inclusion of studies, conducted a comprehensive literature search for studies, assessed risk of bias of the individual included studies, used appropriate methods for quantitative syntheses (meta-analysis) (only assessed if meta-analysis was performed), and had conclusions that were supported by the results of the systematic review. They were classified as unreliable if at least 1 criterion was not met. MAIN OUTCOMES AND MEASURES The proportion of systematic reviews that were reliable and the reasons for unreliability. RESULTS This study identified 98 systematic reviews that addressed interventions for 15 corneal diseases. Thirty-three of 98 systematic reviews (34%) were classified as unreliable. The most frequent reasons for unreliability were that the systematic review did not conduct a comprehensive literature search for studies (22 of 33 [67%]), did not assess risk of bias of the individual included studies (13 of 33 [39%]), and did not use appropriate methods for quantitative syntheses (meta-analysis) (12 of 17 systematic reviews that conducted a quantitative synthesis [71%]). Sixty-five of 98 systematic reviews (66%) were classified as reliable. Forty-two of the 65 reliable systematic reviews (65%) addressed corneal diseases relevant to the 2018 American Academy of Ophthalmology PPPs; 33 of these 42 systematic reviews (79%) are cited in the 2018 PPPs. CONCLUSIONS AND RELEVANCE One in 3 systematic reviews addressing interventions for corneal diseases are unreliable and thus were not used to inform PPP recommendations. Careful adherence by systematic reviewers and journal editors to well-established best practices regarding systematic review conduct and reporting might help make future systematic reviews in eyes and vision more reliable.

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Corneal collagen cross-linking in keratoconus: A systematic review and meta-analysis

Cited by 52 publications

References 39 publications

Cross‐linking in children with keratoconus: a systematic review and meta‐analysis

Cross‐linking in children with keratoconus: a systematic review and meta‐analysis

Thinner Corneas Appear to Have More Striking Effects of Corneal Collagen Crosslinking in Patients with Progressive Keratoconus

Reliability of the Evidence Addressing Treatment of Corneal Diseases

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