Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis
Abstract Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking (CXL) techniques compared with standard epi-off CXL. Methods We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) and non-randomized studies of interventio...
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | Eye and Vision |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40662-021-00256-0 |
| _version_ | 1818622944472989696 |
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| author | Francesco D’Oria Antonio Palazón Jorge L. Alio |
| author_facet | Francesco D’Oria Antonio Palazón Jorge L. Alio |
| author_sort | Francesco D’Oria |
| collection | DOAJ |
| description | Abstract Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking (CXL) techniques compared with standard epi-off CXL. Methods We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) and we evaluated the selected papers according to the Cochrane risk of bias tool. We considered, as primary outcomes, average Kmax flattening, changes in uncorrected and corrected distance visual acuity (UDVA and CDVA); as secondary outcomes, we considered changes in pachymetry values and endothelial cell density (ECD). We also investigated adverse events related to the treatments and treatment failure. Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference (MD) with 95% confidence interval (CI) as the effect size. Results A total of 15 studies were included and among these 15 trials, 9 were RCTs and 6 were NRSIs, but only 4 studies showed no high risk of bias and were included in this meta-analysis. Our analysis revealed significant postoperative differences in CDVA (MD = 0.07; 95% CI 0.04 to 0.10; P < 0.001), and no significative differences in UDVA, Kmax, central corneal thickness (CCT) and ECD (P > 0.05). Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing (P = 0.035) and persistent stromal haze (P = 0.026). Conclusion Epi-on CXL is as effective as epi-off CXL. Except for a higher significant improvement in CDVA with current epi-on protocols, our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual, topographic, pachymetric, and endothelial parameters. Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze. |
| first_indexed | 2024-12-16T18:33:13Z |
| format | Article |
| id | doaj.art-6a54c667cfcf4302bae043f4b69f5266 |
| institution | Directory Open Access Journal |
| issn | 2326-0254 |
| language | English |
| last_indexed | 2024-12-16T18:33:13Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Eye and Vision |
| spelling | doaj.art-6a54c667cfcf4302bae043f4b69f52662022-12-21T22:21:14ZengBMCEye and Vision2326-02542021-09-018111510.1186/s40662-021-00256-0Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysisFrancesco D’Oria0Antonio Palazón1Jorge L. Alio2Vissum InnovationDepartment of Clinical Medicine, Miguel Hernández UniversityVissum InnovationAbstract Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking (CXL) techniques compared with standard epi-off CXL. Methods We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) and we evaluated the selected papers according to the Cochrane risk of bias tool. We considered, as primary outcomes, average Kmax flattening, changes in uncorrected and corrected distance visual acuity (UDVA and CDVA); as secondary outcomes, we considered changes in pachymetry values and endothelial cell density (ECD). We also investigated adverse events related to the treatments and treatment failure. Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference (MD) with 95% confidence interval (CI) as the effect size. Results A total of 15 studies were included and among these 15 trials, 9 were RCTs and 6 were NRSIs, but only 4 studies showed no high risk of bias and were included in this meta-analysis. Our analysis revealed significant postoperative differences in CDVA (MD = 0.07; 95% CI 0.04 to 0.10; P < 0.001), and no significative differences in UDVA, Kmax, central corneal thickness (CCT) and ECD (P > 0.05). Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing (P = 0.035) and persistent stromal haze (P = 0.026). Conclusion Epi-on CXL is as effective as epi-off CXL. Except for a higher significant improvement in CDVA with current epi-on protocols, our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual, topographic, pachymetric, and endothelial parameters. Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.https://doi.org/10.1186/s40662-021-00256-0Corneal collagen cross-linkingKeratoconusTransepithelial CXLEpithelium-off CXLEpithelium-on CXLIontophoresis |
| spellingShingle | Francesco D’Oria Antonio Palazón Jorge L. Alio Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis Eye and Vision Corneal collagen cross-linking Keratoconus Transepithelial CXL Epithelium-off CXL Epithelium-on CXL Iontophoresis |
| title | Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis |
| title_full | Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis |
| title_fullStr | Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis |
| title_full_unstemmed | Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis |
| title_short | Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis |
| title_sort | corneal collagen cross linking epithelium on vs epithelium off a systematic review and meta analysis |
| topic | Corneal collagen cross-linking Keratoconus Transepithelial CXL Epithelium-off CXL Epithelium-on CXL Iontophoresis |
| url | https://doi.org/10.1186/s40662-021-00256-0 |
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