Corneal Stability Comparison Between Simultaneous Cross-Linking With Laser Refractive Surgery Versus Laser Refractive Surgery Alone For Myopia: A Meta-Analysis
Published 2024 - 42nd Congress of the ESCRS
Reference: PO682 | Type: Poster | DOI: 10.82333/4jh0-fj95
Authors: Shuang-An Yang* 1 , Shiow-Wen Liou 2 , Chun-Chen Chen 1
1Ophthalmology,Taipei City Hospital Renai Branch,Taipei City,Taiwan, Province of China, 2Ophthalmology,Shin Kong Wu Ho-Su Memorial Hospital,Taipei City,Taiwan, Province of China
Purpose
To summarize whether corneal cross-linking (CXL) with laser refractive surgery improves corneal stability more than laser refractive surgery alone for myopia.
Setting
A systemic review and meta-analysis
Methods
Six electronic databases were systematically searched from inception to Aug, 2023. Studies comparing the effects of prophylactic corneal CXL with laser refractive surgery versus laser refractive surgery alone in myopic eyes were included. Primary outcome measures included post-operative changes of keratometry, refraction, corneal thickness, endothelial cell density, and both corrected and uncorrected distance visual acuity (CDVA/UDVA) as the surrogate parameters to corneal stability, measured from post-operative 1-12 and 1-24 months. Meta-analysis was performed using random-effect models, and potential sources of heterogeneity were explored by subgroup analyses of surgery type and myopic level.
Results
Twelve eligible studies with 1,252 eyes met our inclusion criteria. Compared to those receiving laser refractive surgery alone, patients who received prophylactic CXL with laser refractive surgery had significantly less UDVA and CDVA decrease within post-operative 12 months (UDVA:WMD -0.04, 95% CI -0.06-(-0.01), p=0.01/CDVA: WMD -0.01, 95% CI -0.03-(-0.00), p=0.02). Furthermore, patients with spherical equivalent -5.0 Diopter (UDVA:WMD -0.04, 95% CI -0.07-(-0.02), p<0.001/ CDVA: WMD -0.02, 95% CI -0.03-(-0.01), p<0.001) or receiving LASIK procedures (UDVA:WMD -0.03, 95% CI -0.06-(-0.01), p=0.01) were associated with more profound visual stability after prophylactic CXL.
Conclusions
For visual outcome, prophylactic CXL with laser refractive surgery, compared to laser refractive surgery alone, provided more stability within post-operative one-year among myopic patients with comparable efficacy and predictability. Particularly, those with higher myopia or receiving LASIK procedure as refractive surgery benefited more from prophylactic CXL.