Department of Ophthalmology, Keio University, School of Medicine, Tokyo, Japan.
Cornea. 2020 Feb;39(2):172-180. doi: 10.1097/ICO.0000000000002092.
To compare the clinical results of accelerated corneal collagen cross-linking (ACXL) to standard corneal collagen cross-linking (SCXL) in progressive keratoconus by summarizing randomized controlled trials using a meta-analysis.
Trials meeting the selection criteria were quality appraised, and data were extracted by 2 independent authors. A comprehensive search was performed using the Cochrane methodology to evaluate the clinical outcomes of ACXL and SCXL for treating progressive keratoconus. Estimates were evaluated by weighted mean difference (WMD) and 95% confidence interval (CI) for absolute changes of the outcomes during 12-month observation periods. Postoperative demarcation line depth was also compared.
We identified 6 randomized controlled trials that met the eligibility criteria for this meta-analysis. SCXL resulted in a significantly better outcome in postoperative changes in best spectacle-corrected visual acuity (WMD = -0.02; 95% CI, -0.03 to -0.01; P < 0.0001); however, the small differences may not be clinically significant. ACXL provided a significantly better improvement of cylindrical refraction after the 1-year follow-up (WMD = 0.15; 95% CI, 0.05-0.26; P = 0.005). Demarcation line depth at 1 month after SCXL was deeper than that after ACXL (WMD = -102.25; 95% CI, -157.16 to -47.35; P = 0.0003). No differences in the changes in maximum keratometry, central corneal thickness, uncorrected visual acuity, spherical equivalent refraction, corneal biomechanical properties, and corneal endothelial cell density were found among both groups.
An ACXL shows a comparable efficacy and safety profile at the 1-year follow-up, but it has less impact on improving best spectacle-corrected visual acuity when compared with the Dresden protocol. Overall, both methods similarly stop the disease progression.
通过对使用荟萃分析的随机对照试验进行总结，比较加速角膜胶原交联（ACXL）与标准角膜胶原交联（SCXL）治疗进行性圆锥角膜的临床效果。
对符合选择标准的试验进行质量评估，并由 2 名独立作者提取数据。使用 Cochrane 方法进行全面搜索，以评估 ACXL 和 SCXL 治疗进行性圆锥角膜的临床疗效。使用加权均数差（WMD）和 95％置信区间（CI）评估 12 个月观察期内各项结果的绝对变化，进行评估。还比较了术后分界线深度。
我们确定了 6 项符合本荟萃分析纳入标准的随机对照试验。SCXL 在术后最佳矫正视力（BCVA）变化方面的结果明显更好（WMD = -0.02；95％CI，-0.03 至-0.01；P <0.0001）；然而，这些微小差异可能在临床上无意义。ACXL 在 1 年随访后柱镜屈光度的改善明显更好（WMD = 0.15；95％CI，0.05-0.26；P = 0.005）。SCXL 治疗后 1 个月分界线深度比 ACXL 治疗后深（WMD = -102.25；95％CI，-157.16 至-47.35；P = 0.0003）。两组之间在最大角膜曲率、中央角膜厚度、未矫正视力、等效球镜屈光度、角膜生物力学特性和角膜内皮细胞密度的变化方面无差异。
ACXL 在 1 年随访时显示出相当的疗效和安全性，但与德累斯顿方案相比，改善最佳矫正视力的效果较小。总体而言，两种方法都能相似地阻止疾病进展。
