Journal article
Safety and Efficacy of Epithelium-Off Corneal Collagen Cross-Linking for the Treatment of Corneal Ectasia: A Report by the American Academy of Ophthalmology
Ophthalmology (Rochester, Minn.), Vol.131(10), pp.1234-1242
06/26/2024
DOI: 10.1016/j.ophtha.2024.05.006
Abstract
To review the evidence on the safety and effectiveness of epithelium-off corneal collagen cross-linking (CXL) for the treatment of progressive corneal ectasia.PURPOSETo review the evidence on the safety and effectiveness of epithelium-off corneal collagen cross-linking (CXL) for the treatment of progressive corneal ectasia.A literature search of the PubMed database was most recently conducted in March 2024 with no date restrictions and limited to studies published in English. The search identified 359 citations that were reviewed in abstract form, and 43 of these were reviewed in full text. High-quality randomized clinical trials comparing epithelium-off CXL with conservative treatment in patients who have keratoconus (KCN) and post-refractive surgery ectasia were included. The panel deemed 6 articles to be of sufficient relevance for inclusion, and these were assessed for quality by the panel methodologist; 5 were rated level I, and 1 was rated level II. There were no level III studies.METHODSA literature search of the PubMed database was most recently conducted in March 2024 with no date restrictions and limited to studies published in English. The search identified 359 citations that were reviewed in abstract form, and 43 of these were reviewed in full text. High-quality randomized clinical trials comparing epithelium-off CXL with conservative treatment in patients who have keratoconus (KCN) and post-refractive surgery ectasia were included. The panel deemed 6 articles to be of sufficient relevance for inclusion, and these were assessed for quality by the panel methodologist; 5 were rated level I, and 1 was rated level II. There were no level III studies.This analysis includes 6 prospective, randomized controlled trials that evaluated the use of epithelium-off CXL to treat progressive KCN (5 studies) and post-laser refractive surgery ectasia (1 study), with a mean postoperative follow-up of 2.4 years (range, 1-5 years). All studies showed a decreased progression rate in treated patients compared with controls. Improvement in the maximum keratometry (Kmax) value, corrected distance visual acuity (CDVA), and uncorrected distance visual acuity (UDVA) was observed in the treatment groups compared with control groups. A decrease in corneal thickness was observed in both groups but was greater in the CXL group. Complications were rare.RESULTSThis analysis includes 6 prospective, randomized controlled trials that evaluated the use of epithelium-off CXL to treat progressive KCN (5 studies) and post-laser refractive surgery ectasia (1 study), with a mean postoperative follow-up of 2.4 years (range, 1-5 years). All studies showed a decreased progression rate in treated patients compared with controls. Improvement in the maximum keratometry (Kmax) value, corrected distance visual acuity (CDVA), and uncorrected distance visual acuity (UDVA) was observed in the treatment groups compared with control groups. A decrease in corneal thickness was observed in both groups but was greater in the CXL group. Complications were rare.Epithelium-off CXL is effective in reducing the progression of KCN and post-laser refractive surgery ectasia in most treated patients with an acceptable safety profile.CONCLUSIONSEpithelium-off CXL is effective in reducing the progression of KCN and post-laser refractive surgery ectasia in most treated patients with an acceptable safety profile.Proprietary or commercial disclosure may be found after the references.FINANCIAL DISCLOSURE(S)Proprietary or commercial disclosure may be found after the references.
Details
- Title: Subtitle
- Safety and Efficacy of Epithelium-Off Corneal Collagen Cross-Linking for the Treatment of Corneal Ectasia: A Report by the American Academy of Ophthalmology
- Creators
- Maria S Cortina - University of Illinois at ChicagoMark A Greiner - University of IowaAnthony N Kuo - University of Illinois at ChicagoJennifer Y Li - University of California, DavisDarby D Miller - University of Illinois at ChicagoRoni M Shtein - University of Michigan–Ann ArborPeter B Veldman - University of ChicagoJia Yin - Harvard Medical SchoolStephen J Kim - Vanderbilt UniversityJoanne F Shen - Mayo Clinic in Arizona
- Resource Type
- Journal article
- Publication Details
- Ophthalmology (Rochester, Minn.), Vol.131(10), pp.1234-1242
- Publisher
- ELSEVIER SCIENCE INC
- DOI
- 10.1016/j.ophtha.2024.05.006
- ISSN
- 1549-4713
- eISSN
- 1549-4713
- Grant note
Prepared by the Ophthalmic Technology Assessment Committee Cornea Panel and approved by the American Academy of Ophthalmology's ' s of Trustees April 19, 2024.
- Language
- English
- Electronic publication date
- 06/26/2024
- Academic Unit
- Ophthalmology and Visual Sciences; Pharmaceutical Sciences and Experimental Therapeutics
- Record Identifier
- 9984648574402771
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