Corneal collagen cross‑linking epithelium‑on ***‑off:a systematic review and meta‑analysis
作者机构：Vissum Innovationc/Cabañal103016 AlicanteSpain Division of OphthalmologyUniversidad Miguel HernándezAlicanteSpain Section of OphthalmologyDepartment of Basic Medical ScienceNeuroscience and Sense OrgansUniversity of BariBariItaly Department of Clinical MedicineMiguel Hernández UniversitySan Juan de AlicanteSpain
出 版 物：《Eye and Vision》 (眼视光学杂志（英文）)
年 卷 期：2021年第8卷第6期
页 面：338-352页
核心收录：
学科分类：1002[医学-临床医学] 100212[医学-眼科学] 10[医学]
基 金：financed in part by the Network for Cooperative Research in Health“OFTARED”—Reference:RD16/0008/0012 Funded by Instituto de Salud Carlos III co-funded by the European Regional Development Fund(ERDF),Project"A way to make Europe"
主 题：Corneal collagen cross-linking Keratoconus Transepithelial CXL Epithelium-off CXL Epithelium-on CXL Iontophoresis
摘 要：Background:The purpose of the study was to determine the advantages and disadvantages of epi-on corneal crosslinking(CXL)techniques compared with standard epi-off ***: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 *** 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 ***-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect ***: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 *** analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P0.05).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 *** 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 ***-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.
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