Efficacy Comparison Of Combining Crosslinking And Refractive Laser Ablation In Progressive Keratoconus: A Meta-Analysis
Published 2024 - 42nd Congress of the ESCRS
Reference: PO677 | Type: Poster | DOI: 10.82333/ye41-av09
Authors: Oriel Spierer* 1 , Tal Yahalomi 2 , Boris Knyazer 3 , Idan Hecht 4 , Uri Elbaz 4 , Asaf Achiron 4
1Ophthalmology,Wolfson Medical Center and School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University,Tel Aviv,Israel, 2Ophthalmology,Samson Assuta Ashdod Hospital,Ashdod,Israel, 3Ophthalmology,Soroka University Medical Center,Beer-Sheva,Israel, 4Ophthalmology,School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University,Tel Aviv,Israel
Purpose
Corneal collagen cross-linking (CXL) is an effective treatment to arrest keratoconus progression. Recently, several studies demonstrated that simultaneous laser ablation and CXL treatment resulted in improved visual acuity and flatter keratometry values compared to CXL alone. The purpose of this work was to assess the effect of combining corneal collagen cross-linking (CXL) with refractive laser ablation techniques for the treatment of keratoconus.
Setting
Meta-analysis.
Methods
Fifteen studies fulfilled the inclusion and exclusion criteria and were included in the study. We calculated and compared the standardized mean difference (SMD) between CXL alone and CXL plus laser ablation for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive manifest spherical equivalent, sphere and cylinder, K1, K2, and central corneal thickness (CCT).
Results
The CXL plus laser ablation group showed improvement in UCVA LogMAR (SMD: -0.35 (95%CI: -0.67, -0.04; p=0.029]), BCVA logMAR (SMD: -0.17 [95%CI: -0.30, -0.03; p=0.014]), spherical equivalent manifest refraction (SMD:-0.28 [95%CI: 0.06, 0.50, p=0.013]), and change in Kmax (SMD: -0.41 [95%CI: -0.69, -0.13; p=0.004) compared to CXL alone. However, CCT decreased further among patients who underwent CXL plus laser ablation (SMD: -0.37 (95%CI: -0.66, -0.07; p=0.016]). No effect was observed in terms of sphere (p=0.878), cylinder (p=0.859), K1 (p=0.907) or K2 (p=0.169).
Conclusions
Combining refractive laser ablation techniques with standard or accelerated CXL treatment improved visual and refractive outcomes and anterior corneal curvature values. However, it negatively impacted corneal thickness compared to CXL alone.