Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Ophthalmology
Published in: BMC Ophthalmology 1/2017

Open Access 01-12-2017 | Research article

Efficacy and safety of transepithelial corneal collagen crosslinking surgery versus standard corneal collagen crosslinking surgery for keratoconus: a meta-analysis of randomized controlled trials

Authors: Wenwei Li, Bin Wang

Published in: BMC Ophthalmology | Issue 1/2017

Login to get access

Abstract

Background

The aim of this study was to evaluate the efficacy and safety of transepithelial corneal collagen crosslinking (transepithelial CXL) versus standard corneal collagen crosslinking (epithelium-off CXL) on keratoconus.

Methods

Eligible studies were identified by systematically searching PubMed, the Cochrane Library and Embase. Topographic parameters, corrected distant visual acuity (CDVA), uncorrected distant visual acuity (UDVA), and corneal thickness (CT) were assessed by the pooled weighted mean differences (WMDs) of the change from baseline to the end of follow up. Quality was assessed according to Cochrane handbook. And we used Review Manager to analysis the included trials.

Results

Three trials involving 244 eyes were evaluated, with 111 eyes in the standard CXL group and 133 eyes in the transepithelial CXL group. The pooled results showed that there were significant differences between the two groups in maximum keratometry (mean difference = 1.05D, 95% CI 0.19 to 1.92, P = 0.02)),and the standard CXL is more effective in decreasing the maximum keratometry at least 12 months after operation; the transepithelial CXL group gained more improvement in CDVA (mean difference = −0.07, 95% CI -0.12 to −0.02, P = 0.007);there were no significant differences in uncorrected distant visual acuity (UDVA) between the two groups (mean difference = −0.03, 95% CI -0.20 to 0.15, P = 0.75). A similar change was found in corneal thickness (mean difference = 4.35, 95% CI -0.43 to 9.13, P = 0.07)).

Conclusions

The standard CXL is more effective in decreasing the maximum keratometry than the transepithelial CXL; the transepithelial CXL provided favorable visual outcomes; they both exhibit similar safety.
Literature
1.
Hofstetter HW. A keratoscopic survey of 13,395 eyes. Am J Optom Arch Am Acad Optom. 1959;36:3–11.CrossRefPubMed
2.
3.
Corneal O’BD. Collagen cross-linking for corneal Ectasias. In: Alió JL, editor. Keratoconus: recent advances in diagnosis and treatment. Cham: Springer International Publishing; 2017. p. 219–38.
4.
Jenkins AD, Kratochvíl P, Stepto RFT, Suter UW. Glossary of basic terms in polymer science (IUPAC recommendations 1996). In: Pure and applied chemistry, vol. 68; 1996. p. 2287.
5.
Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135:620–7.CrossRefPubMed
6.
De Bernardo M, Capasso L, Lanza M, Tortori A, Iaccarino S, Cennamo M, et al. Long-term results of corneal collagen crosslinking for progressive keratoconus. J Opt. 2015;8:180–6.CrossRef
7.
Raiskup F, Theuring A, Pillunat LE, Spoerl E. Corneal collagen crosslinking with riboflavin and ultraviolet-a light in progressive keratoconus: ten-year results. J Cataract Refract Surg. 2015;41:41–6.CrossRefPubMed
8.
Bonnel S, Berguiga M, Rivoyre B, Bedubourg G, Sendon D, Froussart-Maille F, et al. Demarcation line evaluation of iontophoresis-assisted transepithelial corneal collagen cross-linking for keratoconus. J Refract Surg. 2015;31:36–40.CrossRefPubMed
9.
Cassagne M, Delafoy I, Mesplié N, Fournié P, Cochener B, Malecaze F. Transepithelial corneal collagen crosslinking using iontophoresis: preliminary clinical results. Investig Ophthalmol Vis Sci. 2014;55:4216.
10.
Elsaftawy HS, Ahmed MH, Saif MYS, Mousa R. Sequential intracorneal ring segment implantation and corneal transepithelial collagen cross-linking in keratoconus. Cornea. 2015;34:1420–6.CrossRefPubMed
11.
Lesniak SP, Hersh PS. Transepithelial corneal collagen crosslinking for keratoconus: six-month results. J Cataract Refract Surg. 2014;40:1971–9.CrossRefPubMed
12.
Caruso C, Ostacolo C, Epstein RL, Barbaro G, Troisi S, Capobianco D. Transepithelial corneal cross-linking with vitamin E-enhanced riboflavin solution and abbreviated, low-dose UV-A: 24-month clinical outcomes. Cornea. 2016;35:145–50.CrossRefPubMed
13.
Caporossi A, Mazzotta C, Paradiso AL, Baiocchi S, Marigliani D, Caporossi T. Transepithelial corneal collagen crosslinking for progressive keratoconus: 24-month clinical results. J Cataract Refract Surg. 2013;39:1157–63.CrossRefPubMed
14.
Bikbova G, Bikbov M. Standard corneal collagen crosslinking versus transepithelial iontophoresis-assisted corneal crosslinking, 24 months follow-up: randomized control trial. Acta Ophthalmol. 2016;94:e600–6.CrossRefPubMedPubMedCentral
15.
Soeters N, Wisse RP, Godefrooij DA, Imhof SM, Tahzib NG. Transepithelial versus epithelium-off corneal cross-linking for the treatment of progressive keratoconus: a randomized controlled trial. Am J Ophthalmol. 2015;159:821–8. e823CrossRefPubMed
16.
Serrao S, Lombardo G, Rosati M, Lomoriello DS, Lombardo M. Preliminary results of a randomized controlled trial comparing transepithelial corneal cross-linking with iontophoresis and standard cross-linking in patients with progressive keratoconus. Investig Ophthalmol Vis Sci. 2016;57:2892.
17.
Al Fayez MF, Alfayez S, Alfayez Y. Transepithelial versus epithelium-off corneal collagen cross-linking for progressive keratoconus: a prospective randomized controlled trial. Cornea. 2015;34:S53–6.CrossRefPubMed
18.
Lombardo M, Giannini D, Lombardo G, Serrao S. Randomized controlled trial comparing Transepithelial corneal cross-linking using Iontophoresis with the Dresden protocol in progressive Keratoconus. Ophthalmology. 2017;124:804–12.CrossRefPubMed
19.
Stojanovic A, Zhou W, Utheim TP. Corneal collagen cross-linking with and without epithelial removal: a Contralateral study with 0.5% hypotonic riboflavin solution. Biomed Res Int. 2014;2014:619398.CrossRefPubMedPubMedCentral
20.
21.
22.
Li J, Ji P, Lin X. Efficacy of corneal collagen cross-linking for treatment of keratoconus: a meta-analysis of randomized controlled trials. PLoS One. 2015;10:e0127079.CrossRefPubMedPubMedCentral
23.
Meiri Z, Keren S, Rosenblatt A, Sarig T, Shenhav L, Varssano D. Efficacy of corneal collagen cross-linking for the treatment of Keratoconus: a systematic review and meta-analysis. Cornea. 2016;35:417–28.CrossRefPubMed
24.
Wollensak G, Iomdina E. Biomechanical and histological changes after corneal crosslinking with and without epithelial debridement. J Cataract Refract Surg. 2009;35:540–6.CrossRefPubMed
25.
Caporossi A, Mazzotta C, Baiocchi S, Caporossi T, Paradiso AL. Transepithelial corneal collagen crosslinking for keratoconus: qualitative investigation by in vivo HRT II confocal analysis. Eur J Ophthalmol. 2012;22(suppl 7):S81–8.CrossRefPubMed
26.
Kamaev P, Friedman MD, Sherr E, Muller D. Photochemical kinetics of corneal cross-linking with riboflavin. Invest Ophthalmol Vis Sci. 2012;53:2360.CrossRefPubMed
27.
Greenstein SA, Shah VP, Fry KL, Hersh PS. Corneal thickness changes after corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg. 2011;37:691–700.CrossRefPubMed
Metadata
Title
Efficacy and safety of transepithelial corneal collagen crosslinking surgery versus standard corneal collagen crosslinking surgery for keratoconus: a meta-analysis of randomized controlled trials
Authors
Wenwei Li
Bin Wang
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Ophthalmology / Issue 1/2017
Electronic ISSN: 1471-2415
DOI
https://doi.org/10.1186/s12886-017-0657-2

Other articles of this Issue 1/2017

BMC Ophthalmology 1/2017 Go to the issue

Research article

Postural effects on intraocular pressure and ocular perfusion pressure in patients with non-arteritic anterior ischemic optic neuropathy

Research article

Effect of different incision sites of phacoemulsification on trabeculectomy bleb function: prospective case-control study

Research article

Vitrectomy with internal limiting membrane peeling versus inverted internal limiting membrane flap technique for macular hole-induced retinal detachment: a systematic review of literature and meta-analysis

Research article

Quantitative evaluation of hard exudates in diabetic macular edema after short-term intravitreal triamcinolone, dexamethasone implant or bevacizumab injections

Research article

Increase in esodeviation under cycloplegia with 0.5% tropicamide and 0.5% phenylephrine mixed eye drops in patients with hyperopia and esotropia

Research article

The application of wide-field laser ophthalmoscopy in fundus examination before myopic refractive surgery