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Review
. 2024 Mar 19:18:865-879.
doi: 10.2147/OPTH.S451232. eCollection 2024.

Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis

Dillan Cunha Amaral  1 , Adriano Henrique Gomes Menezes  1 , Luan Cavalcante Vilaça Lima  1 , Adriano Cypriano Faneli  2 , Pedro Fernandes Souza Neto  3 , Ana Laura Caiado Canedo  4 , Denisse Josefina Mora-Paez  5 , Jaime Augusto Ferreira Guedes  5 , Ricardo Noguera Louzada  1 , Bruno Machado Fontes  6
Affiliations
Review

Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis

Dillan Cunha Amaral et al. Clin Ophthalmol. .

Abstract

Introduction: Corneal ectasia leads to progressive irregular corneal curvature and reduced visual acuity.

Objective: To assess the safety and effectiveness of corneal collagen cross-linking (CXL) for managing corneal ectasia resulting from refractive laser surgery (RSL).

Methods: A systematic review and meta-analysis were realized according to PRISMA guidelines. We searched PubMed, EMBASE, Cochrane, and Web of Science databases for studies on CXL in patients with ectasia after RLS. The outcomes of interest included visual acuity, refractive outcomes, topographic parameters (Kmax, index surface variance (ISV), index of Vertical Asymmetry (IVA), keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD) and Rmin (minimum sagittal curvature)), central corneal thickness, endothelial cell count, and possible adverse events. Statistical analysis was performed using the R software (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria).

Results: 15 studies encompassing 421 patients (512 eyes) were included. The mean age was 32.03 ± 4.4 years. The pooled results showed a stable uncorrected visual acuity post-CXL, with a significant improvement in corrected distance visual acuity (SMD = 0.09; 95% CI: -0.07 to 0.26). The spherical equivalent decreased significantly (SMD = -0.09; 95% CI: -0.35, -0.02). The topographic parameter Kmax decreased significantly (SMD = 0.15; 95% CI:0.01 to 0.28); however, the other parameters, ISV, IVA, KI, CKI, IHA, IHD, and Rmin, did not change significantly. Central corneal thickness decreased significantly (SMD = 0.24; 95% CI:0.07 to 0.41), and the endothelial cell count remained stable The complications were rare.

Conclusion: CXL is a safe and effective technique for managing corneal ectasia after RLS.

Keywords: corneal ectasia; cross-linking; laser refractive surgery; meta-analysis; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
UCVA forest plot.
Figure 3
Figure 3
CDVA forest plot.
Figure 4
Figure 4
SE forest plot.
Figure 5
Figure 5
Kmax forest plot.
Figure 6
Figure 6
ISV forest plot.
Figure 7
Figure 7
IVA forest plot.
Figure 8
Figure 8
KI forest plot.
Figure 9
Figure 9
CKI forest plot.
Figure 10
Figure 10
Rmin forest plot.
Figure 11
Figure 11
IHA forest plot.
Figure 12
Figure 12
IHD forest plot.
Figure 13
Figure 13
EEC forest plot.
Figure 14
Figure 14
CCT forest plot.
Figure 15
Figure 15
Serious Complications rates.
See this image and copyright information in PMC

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