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The efficacy of standard versus accelerated epi-off corneal cross-linking protocols: a systematic review and sub-group analysis

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Abstract

Purpose

To compare the one-year efficacy of accelerated and standard 5.4 J/cm2 protocols of cross-linking (CXL) in the treatment of progressive keratoconus.

Methods

In this systematic review, two members of the research team searched Scopus, Pubmed, ISI, Ovid, Science Direct, and Cochrane databases independently for publications between January 2010 and December 2016. The majority of retrieved studies were not randomized clinical trials (RCT), or the second arm of the RCT was either untreated or customized CXL. The outcomes of interest were uncorrected distance visual acuity, corrected visual acuity, manifest refraction spherical equivalent, maximum keratometry in the central 3 mm, minimum keratometry in the central 3 mm, and corneal thickness in the apex or thinnest point at baseline and 1 year after CXL.

Results

Of the 453 papers found in the preliminary search, 23 papers were included in the final analysis. Analysis of variance of one-year changes showed that longer irradiation times were associated with a greater corneal flattening effect, although there was no difference in terms of improvement in vision or refraction.

Conclusions

In other words, efficacy is comparable among different CXL protocols, so it is recommended to use the standard method in cases where maximum flattening is expected, such as young people and severe cases.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran

    Mohammad Miraftab & Soheila Asgari

  2. Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali’asr Ave., Tehran, Iran

    Hassan Hashemi

  3. The Institute of Pharmaceutical Sciences (TIPS), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Abdollahi

  4. Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    Shekoufeh Nikfar

  5. The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran

    Shekoufeh Nikfar

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  1. Mohammad Miraftab
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  2. Hassan Hashemi
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  4. Shekoufeh Nikfar
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  5. Soheila Asgari
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Correspondence to Hassan Hashemi.

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Miraftab, M., Hashemi, H., Abdollahi, M. et al. The efficacy of standard versus accelerated epi-off corneal cross-linking protocols: a systematic review and sub-group analysis. Int Ophthalmol 39, 2675–2683 (2019). https://doi.org/10.1007/s10792-019-01091-y

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