Wan Qi, Wang Dan, Ye HongQuan, Tang Jing, Han Yu
The People's Hospital of Leshan, Leshan City, China.
J Curr Ophthalmol. 2017 Mar 15;29(3):145-153. doi: 10.1016/j.joco.2017.02.008. eCollection 2017 Sep.
The aim of this study was to review the safety and stability of cornea cross-linking (CXL) for the treatment of keratectasia after Excimer Laser Refractive Surgery.
Eligible studies were identified by systematically searching PubMed, Embase, Web of Science and reference lists. Meta-analysis was performed using Stata 12.1 software. The primary outcome parameters included the changes of corrected distant visual acuity (CDVA), uncorrected visual acuity (UCVA), the maximum keratometry value (Kmax) and minimum keratometry value (Kmin), the surface regularity index (SRI), the surface asymmetry index (SAI), the keratoconus prediction index (KPI), corneal thickness, and endothelial cell count. Efficacy estimates were evaluated by weighted mean difference (WMD) and 95% confidence interval (CI) for absolute changes of the interested outcomes.
Seven studies involving 118 patients treated with CXL for progressive ectasia after laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) (140 eyes; the follow-up time range from 12 to 62 months) were included in the meta-analysis. The pooled results showed that there were no significant differences in Kmax and Kmin values after CXL (WMD = 0.584; 95% CI: -0.289 to 1.458; = 0.19; WMD = 0.466; 95% CI: -0.625 to 1.556; = 0.403, respectively). The CDVA improved significantly after CXL (WMD = 0.045; 95% CI: 0.010 to 0.079; = 0.011), whereas UCVA did not differ statistically (WMD = 0.011; 95% CI: -0.055 to 0.077; = 0.746). The changes were not statistically significant in SRI, SAI, and KPI (WMD = 0.116; 95% CI: -0.090 to 0.322; = 0.269; WMD = 0.240; 95% CI: -0.200 to 0.681; = 0.285; WMD = 0.045; 95% CI: -0.001 to 0.090; = 0.056, respectively). Endothelial cell count and corneal thickness did not deteriorate (WMD = 12.634; 95% CI: -29.460 to 54.729; = 0.556; WMD = 0.657; 95% CI: -9.402 to 10.717; = 0.898, respectively).
The study showed that CXL is a promising treatment to stabilize the keratectasia after Excimer Laser Refractive Surgery. Further long-term follow-up studies are necessary to assess the persistence of the effect of the CXL.
本研究旨在回顾角膜交联术（CXL）治疗准分子激光屈光手术后角膜扩张的安全性和稳定性。
通过系统检索PubMed、Embase、Web of Science及参考文献列表来确定符合条件的研究。使用Stata 12.1软件进行荟萃分析。主要结局参数包括矫正远视力（CDVA）、未矫正视力（UCVA）、最大角膜曲率值（Kmax）和最小角膜曲率值（Kmin）、表面规则性指数（SRI）、表面不对称指数（SAI）、圆锥角膜预测指数（KPI）、角膜厚度和内皮细胞计数。通过加权均数差（WMD）和95%置信区间（CI）评估感兴趣结局的绝对变化的疗效估计值。
荟萃分析纳入了7项研究，共118例接受CXL治疗激光原位角膜磨镶术（LASIK）或准分子激光角膜切削术（PRK）后进展性角膜扩张的患者（140只眼；随访时间为12至62个月）。汇总结果显示，CXL术后Kmax和Kmin值无显著差异（WMD = 0.584；95% CI：-0.289至1.458；P = 0.19；WMD = 0.466；95% CI：-0.625至1.556；P = 0.403）。CXL术后CDVA显著改善（WMD = 0.045；95% CI：0.010至0.079；P = 0.011），而UCVA无统计学差异（WMD = 0.011；95% CI：-0.055至0.077；P = 0.746）。SRI、SAI和KPI的变化无统计学意义（WMD = 0.116；95% CI：-0.090至0.322；P = 0.269；WMD = 0.240；95% CI：-0.200至0.681；P = 0.285；WMD = 0.045；95% CI：-0.001至0.090；P = 0.056）。内皮细胞计数和角膜厚度没有恶化（WMD = 12.634；95% CI：-29.460至54.729；P = 0.556；WMD = 0.657；95% CI：-9.402至10.717；P = 0.898）。
该研究表明，CXL是稳定准分子激光屈光手术后角膜扩张的一种有前景的治疗方法。需要进一步的长期随访研究来评估CXL效果的持久性。
