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Epithelium-Off Photochemical Corneal Collagen Cross-Linkage Using Riboflavin and Ultraviolet A for Keratoconus and Keratectasia: A Systematic Review and Meta-Analysis

Lookup NU author(s): Professor Francisco Figueiredo


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This report presents the results of a systematic review and meta-analyses of studies on epithelium-off photochemical corneal collagen cross-linkage for the management of keratoconus and secondary ectasia. The literature search identified 3,400 records of which 49 were considered for inclusion in the meta-analyses. Eight papers reported 4 unique randomized controlled trials, 29 studies were prospective, and 12 were retrospective studies. The majority of the studies (39/49) were graded as very low quality evidence. Twenty-six studies described adverse events and were included in the safety analysis. Meta-analyses are presented for changes in four outcomes: visual acuity, topography, refraction and astigmatism, and central corneal thickness. Statistically significant improvements were found in all efficacy outcomes at 12 months after the operation. Common side effects were pain, corneal edema, and corneal haze, which resolved usually within a few days after the procedure. The remaining uncertainty is duration of benefit to establish the procedure's potential benefit in avoiding or delaying disease progression and possibly reducing the need for corneal transplantation.

Publication metadata

Author(s): Craig JA, Mahon J, Yellowlees A, Barata T, Glanville J, Arber M, Mandava L, Powell J, Figueiredo F

Publication type: Review

Publication status: Published

Journal: The Ocular Surface

Year: 2014

Volume: 12

Issue: 3

Pages: 202-214

Print publication date: 01/07/2014

Online publication date: 14/05/2014

Acceptance date: 02/05/2014

ISSN (print): 1542-0124

ISSN (electronic): 1937-5913



DOI: 10.1016/j.jtos.2014.05.002

PubMed id: 24999102