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Comparison of epithelium-off vs transepithelial corneal collagen cross-linking for keratoconus: a systematic review and meta-analysis

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Session Details

Session Title: Cross-Linking Protocols

Session Date/Time: Monday 24/09/2018 | 14:00-16:00

Paper Time: 15:32

Venue: Room A3, Podium 3

First Author: : J.Huang CHINA

Co Author(s): :    B. Song   D. Wen   C. McAlinden   D. David O'Brart   Q. Wang        

Abstract Details


To systematically compare standard epithelium-off (SCXL) and transepithelial corneal collagen crosslinking (TECXL) for treating keratoconus.


Eye Hospital, Wenzhou Medical University, Wenzhou, China.


PubMed, Embase, the Cochrane Library, the US trial registry (, VIP Database, Wanfang Databse and China National Knowledge Infrastructure (CNKI) were conducted up to February 2017. Primary outcomes were changes at 1 year in uncorrected distance visual acuity (UDVA), maximum keratometry (Kmax) and mean keratometry (mean K). Secondary outcomes were changes at 1 year in corrected distance visual acuity (CDVA), mean refractive spherical equivalent (MRSE), central corneal thickness (CCT) and endothelial cell density (ECD), and the occurrence of adverse events.


Eight studies with a total of 455 eyes were included. For primary outcomes, SCXL showed a greater reduction in mean K (SMD 0.28; 95% CI 0.03 to 0.53; p=0.03) compared to TECXL. Sub-group analysis indicated that SCXL had a comparable effect on reducing mean K with TECXL protocols using chemical enhancers (SMD 0.05; 95% CI -0.36 to 0.45; p=0.82) but a greater reduction in mean K compared to TECXL with current iontophoretic protocols (SMD 0.43; 95% CI 0.10 to 0.75; p=0.01). For the other outcomes, there were no statistically significant differences.


With the exception of a reduction in mean K with current iontophoretic protocols, analysis of the limited number of comparative studies available appears to demonstrate that SCXL and TECXL have a comparable effect on visual, refractive, pachymetric and endothelial parameters 1 year following surgery. Further follow-up is required to determine whether these techniques are comparable in the long-term.

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