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Network meta-analysis comparing efficacy and safety of different protocols of corneal cross-linking for the treatment of progressive keratoconus

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Abstract

Purpose

This study aimed to determine the preferred protocol of corneal collagen cross-linking (CXL) in the treatment of progressive keratoconus.

Methods

Relevant studies were retrieved in PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL). Maximum keratometry value (Kmax), best spectacle-corrected visual acuity (BSCVA), manifest refraction spherical equivalent (MRSE), and endothelial cell density (ECD) were evaluated in network meta-analysis.

Results

Eight randomized controlled trials (RCTs) were included. Low-level evidence suggested that aCXL with 30mW/cm2 for 3 min (aCXL-3) might be the best protocol for reducing BSCVA (65.22%) but worst protocol for reducing MRSE (51.53%). aCXL with 18mW/cm2 for 5 min (aCXL-5) might be the best protocol for reducing Kmax (39.58%) and MRSE (77.85%) but might be the worst for preserving ECD (50.98%). aCXL with 9mW/cm2 for 10 min (aCXL-10) might be the best protocol for preserving ECD (31.53%).

Conclusion

Overall, three protocols of aCXL are comparable in therapeutic efficacy and safety for treating progressive keratoconus. Despite no direct data comparing the efficacy of each technique according to different patients' profiles, it is reasonable to state that aCXL-5 may be the best for patients at early-stage to reduce Kmax and MRSE, aCXL-3 may be the best for patients at mid-stage to improve BSCVA, and aCXL-10 may be the best for patients at late-stage to preserve DEC.

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Data availability

All data generated or analyzed during this study are included in this published article/as supplementary information files.

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Acknowledgements

We would like to deeply appreciate all authors who performed all eligible studies which have been included in the present network meta-analysis.

Funding

This study was funded by the National Natural Science Foundation of China (Grant No. 81770955); Project of Shanghai Science and Technology (Grant No.17411950200). The sponsors and funding organizations had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China

    Lan Ding, Ling Sun & Xingtao Zhou

  2. NHC Key Laboratory of Myopia (Fudan University), Shanghai, China

    Lan Ding, Ling Sun & Xingtao Zhou

  3. Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China

    Lan Ding, Ling Sun & Xingtao Zhou

  4. Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China

    Lan Ding, Ling Sun & Xingtao Zhou

Authors
  1. Lan Ding
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  2. Ling Sun
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Contributions

Substantially contributed to conception or design: Ling Sun, Xingtao Zhou. Contributed to acquisition, analysis, or interpretation of data: Lan Ding. Drafted the manuscript for important content: Ling Sun. Critically revised the manuscript for important intellectual content: Xingtao Zhou. Gave final approval: All authors.

Corresponding author

Correspondence to Xingtao Zhou.

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This article does not contain any studies with human participants or animals performed by any of the authors. This study is a meta-analysis and does not involve ethical approval.

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Ding, L., Sun, L. & Zhou, X. Network meta-analysis comparing efficacy and safety of different protocols of corneal cross-linking for the treatment of progressive keratoconus. Graefes Arch Clin Exp Ophthalmol 261, 2743–2753 (2023). https://doi.org/10.1007/s00417-023-06026-z

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