AUTHOR=Li Yuanjun , Lu Ying , Du Kaixuan , Yin Yewei , Hu Tu , Fu Yanyan , Xiang Aiqun , Fu Qiuman , Wu Xiaoying , Wen Dan 

TITLE=Comparison of Efficacy and Safety Between Standard, Accelerated Epithelium-Off and Transepithelial Corneal Collagen Crosslinking in Pediatric Keratoconus: A Meta-Analysis

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.787167

DOI=10.3389/fmed.2022.787167

ISSN=2296-858X

ABSTRACT=<sec><title>Purpose</title><p>The purpose of the study is to compare the efficacy of standard epithelium-off CXL (SCXL), accelerated epithelium-off CXL (ACXL), and transepithelial crosslinking CXL (TECXL) for pediatric keratoconus.</p></sec><sec><title>Methods</title><p>A literature search on the efficacy of SCXL, ACXL, and TECXL [including accelerated TECXL (A-TECXL)] for keratoconus patients younger than 18 years was conducted using PubMed, Cochrane Library, <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, and EMBASE up to 2021. Primary outcomes were changes in uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) after CXL. Secondary outcomes were changes in best-corrected visual acuity (BCVA), mean refractive spherical equivalent (MRSE), and central corneal thickness (CCT). Estimations were analyzed by weighted mean difference (WMD) and 95% confidence interval (CI).</p></sec><sec><title>Results</title><p>A number of eleven identified studies enrolled 888 eyes (SCXL: 407 eyes; ACXL: 297 eyes; TECXL: 28 eyes; A-TECXL: 156 eyes). For pediatric keratoconus, except for a significant greater improvement in BCVA at 24-month follow-up in SCXL (WMD = –0.08, 95%CI: –0.14 to –0.01, <italic>p</italic> = 0.03, I<sup>2</sup> = 71%), no significant difference was observed in other outcomes between the SCXL and ACXL groups. SCXL seems to provide greater changes in UCVA (WMD = –0.24, 95% CI: –0.34 to –0.13, <italic>p</italic> &lt; 0.00001, I<sup>2</sup> = 89%), BCVA (WMD = –0.09, 95% CI: –0.15 to –0.04, <italic>p</italic> = 0.0008, I<sup>2</sup> = 94%), and Kmax (WMD = –1.93, 95% CI: –3.02 to –0.85, <italic>p</italic> = 0.0005, I<sup>2</sup> = 0%) than A-TECXL, with higher incidence of adverse events.</p></sec><sec><title>Conclusion</title><p>For pediatric keratoconus, both SCXL and ACXL appear to be comparable in the efficacy of visual effects and keratometric outcomes; SCXL seems to provide greater changes in visual and pachymetric outcomes than A-TECXL.</p></sec>