Li Yuanjun, Lu Ying, Du Kaixuan, Yin Yewei, Hu Tu, Fu Yanyan, Xiang Aiqun, Fu Qiuman, Wu Xiaoying, Wen Dan
Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Front Med (Lausanne). 2022 Mar 17;9:787167. doi: 10.3389/fmed.2022.787167. eCollection 2022.
The purpose of the study is to compare the efficacy of standard epithelium-off CXL (SCXL), accelerated epithelium-off CXL (ACXL), and transepithelial crosslinking CXL (TECXL) for pediatric keratoconus.
A literature search on the efficacy of SCXL, ACXL, and TECXL [including accelerated TECXL (A-TECXL)] for keratoconus patients younger than 18 years was conducted using PubMed, Cochrane Library, ClinicalTrials.gov, and EMBASE up to 2021. Primary outcomes were changes in uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) after CXL. Secondary outcomes were changes in best-corrected visual acuity (BCVA), mean refractive spherical equivalent (MRSE), and central corneal thickness (CCT). Estimations were analyzed by weighted mean difference (WMD) and 95% confidence interval (CI).
A number of eleven identified studies enrolled 888 eyes (SCXL: 407 eyes; ACXL: 297 eyes; TECXL: 28 eyes; A-TECXL: 156 eyes). For pediatric keratoconus, except for a significant greater improvement in BCVA at 24-month follow-up in SCXL (WMD = -0.08, 95%CI: -0.14 to -0.01, = 0.03, I = 71%), no significant difference was observed in other outcomes between the SCXL and ACXL groups. SCXL seems to provide greater changes in UCVA (WMD = -0.24, 95% CI: -0.34 to -0.13, < 0.00001, I = 89%), BCVA (WMD = -0.09, 95% CI: -0.15 to -0.04, = 0.0008, I = 94%), and Kmax (WMD = -1.93, 95% CI: -3.02 to -0.85, = 0.0005, I = 0%) than A-TECXL, with higher incidence of adverse events.
For pediatric keratoconus, both SCXL and ACXL appear to be comparable in the efficacy of visual effects and keratometric outcomes; SCXL seems to provide greater changes in visual and pachymetric outcomes than A-TECXL.
本研究旨在比较标准去上皮角膜交联术（SCXL）、加速去上皮角膜交联术（ACXL）和经上皮角膜交联术（TECXL）治疗儿童圆锥角膜的疗效。
截至2021年，使用PubMed、Cochrane图书馆、ClinicalTrials.gov和EMBASE对SCXL、ACXL和TECXL[包括加速经上皮角膜交联术（A-TECXL）]治疗18岁以下圆锥角膜患者的疗效进行文献检索。主要结局指标为角膜交联术后未矫正视力（UCVA）和最大角膜曲率（Kmax）的变化。次要结局指标为最佳矫正视力（BCVA）、平均等效球镜度（MRSE）和中央角膜厚度（CCT）的变化。采用加权均数差（WMD）和95%置信区间（CI）进行分析。
11项纳入研究共纳入888只眼（SCXL：407只眼；ACXL：297只眼；TECXL：28只眼；A-TECXL：156只眼）。对于儿童圆锥角膜，除SCXL组在24个月随访时BCVA改善更显著（WMD=-0.08，95%CI：-0.14至-0.01，P=0.03，I²=71%）外，SCXL组和ACXL组在其他结局指标上未观察到显著差异。与A-TECXL相比，SCXL在UCVA（WMD=-0.24，95%CI：-0.34至-0.13，P<0.00001，I²=89%）、BCVA（WMD=-0.09，95%CI：-0.15至-0.04，P=0.0008，I²=94%）和Kmax（WMD=-1.93，95%CI：-3.02至-0.85，P=0.0005，I²=0%）方面似乎有更大变化，且不良事件发生率更高。
对于儿童圆锥角膜，SCXL和ACXL在视觉效果和角膜曲率测量结果的疗效上似乎相当；SCXL在视觉和角膜厚度测量结果方面似乎比A-TECXL有更大变化。
