Short- and long-term safety and efficacy of corneal collagen cross-linking in progressive keratoconus: A systematic review and m eta-analysis of randomized controlled trials

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dc.contributor.authorSarma, Phulen
dc.contributor.authorKaur, Hardeep
dc.contributor.authorHafezi, Farhad
dc.contributor.authorBhattacharyya, Jaimini
dc.contributor.authorKirubakaran, Richard
dc.contributor.authorPrajapat, Manisha
dc.contributor.authorMedhi, Bikash
dc.contributor.authorDas, Kalyan
dc.contributor.authorPrakash, Ajay
dc.contributor.authorSingh, Ashutosh
dc.contributor.authorKumar, Subodh
dc.contributor.authorSingh, Rahul
dc.contributor.authorReddy, Dibbanti
dc.contributor.authorKaur, Gurjeet
dc.contributor.authorSharma, Saurabh
dc.contributor.authorBhattacharyya, Anusuya
dc.date.accessioned2024-01-21T10:55:08Z
dc.date.accessioned2024-08-14T07:44:22Z
dc.date.available2024-01-21T10:55:08Z
dc.date.available2024-08-14T07:44:22Z
dc.date.issued2022-11-25T00:00:00
dc.description.abstractPURPOSE: The purpose of the study is to evaluate the safety and outcomes of corneal collagen cross-linking (CXL) and different CXL protocols in progressive keratoconus (PK) population at short and long-term. MATERIALS AND METHODS: A systematic review and meta-analysis was conducted. A total of eight literature databases were searched (up to February 15, 2022). Randomized controlled trials (RCTs) comparing CXL versus placebo/control or comparing different CXL protocols in the PK population were included. The primary objective was assessment of outcomes of CXL versus placebo and comparison of different CXL protocols in terms of maximum keratometry (Kmax) or Kmax change from baseline (?), spherical equivalent, best corrected visual acuity (BCVA), and central corneal thickness (CCT) in both at short term (6 months) and long term (1 st, 2 nd, and 3 rd year or more). The secondary objective was comparative evaluation of safety. For the meta-analysis, the RevMan5.3 software was used. RESULTS: A total of 48 RCTs were included. Compared to control, CXL was associated with improvement in ? Kmax at 1 year (4 RCTs, mean difference [MD], -1.78 [-2.71, -0.86], P = 0.0002) and 2 and 3 years (1 RCT); ?BCVA at 1 year (7 RCTs, -0.10 [-0.14, -0.06], P < 0.00001); and ? CCT at 1 year (2 RCTs) and 3 years (1 RCT). Compared to conventional CXL (C-CXL), deterioration in ? Kmax, ?BCVA and endothelial cell density was seen at long term in the transepithelial CXL (TE-CXL, chemical enhancer). Up to 2 years, there was no difference between TE-CXL using iontophoresis (T-ionto) and C-CXL. At 2 and 4 years, C-CXL performed better compared to accelerated CXL (A-CXL) in terms of improving Kmax. Although CCT was higher in the A-CXL arm at 2 years, there was no difference at 4 years. While exploring heterogeneity among studies, selection of control eye (fellow eye of the same patient vs. eye of different patient) and baseline difference in Kmax were important sources of heterogeneity. CONCLUSION: CXL outperforms placebo/control in terms of enhancing Kmax and CCT, as well as slowing disease progression over time (till 3 years). T-ionto protocol, on the other hand, performed similarly to C-CXL protocol up to 2 years. � 2023 Wolters Kluwer Medknow Publications. All rights reserved.en_US
dc.identifier.doi10.4103/2211-5056.361974
dc.identifier.issn22115056
dc.identifier.urihttp://10.2.3.109/handle/32116/4349
dc.identifier.urlhttps://journals.lww.com/10.4103/2211-5056.361974
dc.language.isoen_USen_US
dc.publisherWolters Kluwer Medknow Publicationsen_US
dc.subjectCollagen cross-linkingen_US
dc.subjectcorneaen_US
dc.subjectcross-linkingen_US
dc.subjectkeratoconusen_US
dc.subjectprogressive keratoconusen_US
dc.titleShort- and long-term safety and efficacy of corneal collagen cross-linking in progressive keratoconus: A systematic review and m eta-analysis of randomized controlled trialsen_US
dc.title.journalTaiwan Journal of Ophthalmologyen_US
dc.typeArticleen_US
dc.type.accesstypeOpen Accessen_US

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