Systematic review and Meta-analysis comparing modified cross-linking and standard cross-linking for progressive keratoconus

• 作者: Ai-Peng Li Jing Zhang Qing-Feng Liang Yang Liu Yi Liu Ying Jie Ying-Nan Zhang Zhi-Qiang Pan
• 来源期刊: 国际眼科杂志：英文版
• 学科: 医学
• 年，卷（期）: 2017,（9）
• 页码范围: 1419-1429
• 页数: 11页
• 分类号: R77

摘要

AIM: To compare the effectiveness and safety between modified cross-linking(MC) and standard cross-linking(SC) in mild or moderate progressive keratoconus.METHODS: Eligible studies were retrieved from four electronic databases, including CENTRAL, Clinical Trials gov, Pup Med and OVID MEDLINE. We set post-surgical maximum K value(Kmax) as the primary outcome. In addition, uncorrected and corrected distant visual acuity(UDVA and UDVA), spherical equivalent(SE), endothelial cell density(ECD), central cornea thickness(CCT) and depth of demarcation line(DDL) were Meta-analyzed as secondary outcomes. Mean differences for these outcomes were pooled through either a random-effect model or fixed-effect model according to data heterogeneity.RESULTS: Twenty-four comparative studies either on accelerated cross-linking(AC) compared with SC or on transepithelial cross-linking(TC) compared with SC were included and pooled for analysis. The results indicated that MC was significantly inferior to SC at delaying Kmax deterioration [AC vs SC 0.49(95% CI: 0.04-0.94, I~2=75%, P=0.03); TC vs SC 1.15(95% CI: 0.54-1.75, I~2=50%, P=0.0002)]. SE decreased significantly for SC when compared to AC [0.62(95% CI: 0.38-0.86, I~2=22%, P<0.00001)]. DDL of SC was more significantly deeper than that of TC [-133.49(95% CI:-145.94 to-121.04, I~2=33%, P<0.00001)]. Other outcomes demonstrated comparable results between MC and SC.CONCLUSION: SC is more favorable at halting the progression of keratoconus, but visual acuity improvement showed comparable results between MCs and SC.