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Accelerated vs conventional corneal cross-linking for progressive keratoconus: a meta-analysis of randomised controlled trials

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Session Details

Session Title: Cross-Linking Protocols

Session Date/Time: Monday 24/09/2018 | 14:00-16:00

Paper Time: 15:04

Venue: Room A3, Podium 3

First Author: : H.Kobashi JAPAN

Co Author(s): :    K. Konomi   K. Tsubota                 

Abstract Details


To compare the efficacy and safety of accelerated corneal collagen cross-linking (CXL) to conventional Dresden protocol in progressive keratoconus by summarizing randomized controlled trials (RCTs) using a meta-analysis.


Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.


Cochrane databases and MEDLINE were searched for RCTs. Trials meeting the selection criteria were quality appraised, and the data were extracted by two independent authors. A comprehensive search was performed using the Cochrane Collaboration methodology to evaluate the clinical outcomes of accelerated CXL (18 mW/cm2 or more for 5 min or less) and conventional Dresden protocol (3 mW/cm2 for 30 min) for treating progressive keratoconus. Estimates were evaluated by weighted mean difference (WMD) and 95% confidence interval (CI) for absolute changes of the outcomes during 6-month observation periods. Pooled odds ratio was calculated for the comparison of postoperative corneal haze.


We identified five RCTs involving 337 eyes that met the eligibility criteria for this meta-analysis. Conventional CXL group showed significant greater reduction in post-treatment corneal thickness (WMD=17.36; 95% CI: 10.30 to 24.41; p<0.001). Conventional CXL resulted in significant better outcome in postoperative changes in best spectacle-corrected visual acuity (WMD=0.02; 95% CI: 0.01 to 0.03; p<0.001), however the small differences may not be clinically significant. There was no significant difference between the two groups for changes in maximum keratometry, spherical equivalent refraction, cylindrical refraction, corneal endothelial cell density, and corneal haze (p=0.18, p=0.68, p=0.13, p=0.52, and p=0.40, respectively).


An accelerated CXL shows a comparable outcome and safety profile at 6 months follow-up, but it has less impact on improving best spectacle-corrected visual acuity, when compared to Dresden protocol. Overall, both methods stop the disease progression similarly. A meta-analysis with longer follow-up periods is required.

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