Clinical Ophthalmology (Mar 2024)

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

  • Amaral DC,
  • Menezes AHG,
  • Vilaça Lima LC,
  • Faneli AC,
  • Neto PFS,
  • Canedo ALC,
  • Mora-Paez DJ,
  • Guedes JAF,
  • Louzada RN,
  • Fontes BM

Journal volume & issue
Vol. Volume 18
pp. 865 – 879

Abstract

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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 Fontes6 1Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 2Faculdade de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil; 3Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil; 4Ophthalmology, Hospital Israelita Albert Einstein, Goiânia, GO, Brazil; 5Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; 6Ophthalmology, Opty Group, Rio de Janeiro, RJ, BrazilCorrespondence: Dillan Cunha Amaral, Centro de Ciências da Saúde, Bloco K - Av. Carlos Chagas Filho, 373 - 2° andar, Sala 49 - Cidade Universitária, Rio de Janeiro, RJ, 21044-020, Brazil, Email [email protected]: 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: cross-linking, corneal ectasia, laser refractive surgery, meta-analysis, systematic review

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