Krungkraipetch Luksanaporn, Assawaboonyadech Angkhana, Supajitgulchai Dutdao
Department of Ophthalmology, Faculty of Medicine, Burapha University, Chonburi, Thailand.
Burapha University Hospital, Burapha University, Chonburi, Thailand.
Int Ophthalmol. 2025 Jun 28;45(1):270. doi: 10.1007/s10792-025-03617-z.
To evaluate the changes in corneal biomechanical properties following corneal collagen cross-linking (CXL) in keratoconus patients and determine factors influencing measurement sensitivity through systematic review and meta-regression analysis.
A comprehensive literature search was conducted across PubMed, Scopus, Cochrane Library, and Google Scholar, identifying 8139 records. After duplicate removal and screening, 12 eligible studies (2009-2024) involving various CXL protocols and measurement tools (Corvis ST, Ocular Response Analyzer [ORA], and Ambrsio Relational Thickness [ART]) were included. Risk of bias was assessed using ROBINS-I and the NIH Quality Assessment Tool. Effect sizes were synthesized using random-effects meta-analysis, and heterogeneity was quantified using I statistics. Meta-regression was performed to evaluate associations between corneal stiffness and visual acuity outcomes. Publication bias was assessed through funnel plots, Egger's test, and trim-and-fill analysis.
CXL significantly improved corneal biomechanical properties, particularly when assessed with Corvis ST, which detected changes in 75% of studies, compared to 25% using ORA. Dynamic parameters such as V1, V2, and L2 were more sensitive than standard metrics. Meta-regression revealed a significant correlation between corneal stiffness and visual acuity for Corvis ST (p = 0.02 and p = 0.04, respectively), but not for ORA. The pooled effect size for biomechanical change was 0.74 (95% CI 0.59-0.89), reduced to 0.62 after Trim-and-Fill adjustment, suggesting 16.2% potential publication bias. Egger's test confirmed small-study effects (p = 0.024). Heterogeneity was high (I = 98.3%), attributed to variability in protocols and study designs.
CXL leads to sustained improvements in corneal biomechanical properties in keratoconus patients, with stronger and more consistent detection using dynamic and device-specific metrics, particularly with Corvis ST. While findings support the long-term efficacy of CXL, variability in measurement protocols underscores the need for standardization. Meta-regression confirms the clinical relevance of biomechanical improvements, especially their correlation with visual function.
通过系统评价和Meta回归分析，评估圆锥角膜患者角膜胶原交联（CXL）后角膜生物力学特性的变化，并确定影响测量敏感性的因素。
在PubMed、Scopus、Cochrane图书馆和谷歌学术上进行了全面的文献检索，共识别出8139条记录。在去除重复记录和筛选后，纳入了12项符合条件的研究（2009 - 2024年），这些研究涉及各种CXL方案和测量工具（Corvis ST、眼反应分析仪[ORA]和安布罗西奥相关厚度[ART]）。使用ROBINS - I和美国国立卫生研究院质量评估工具评估偏倚风险。使用随机效应Meta分析合成效应量，并使用I统计量对异质性进行量化。进行Meta回归以评估角膜硬度与视力结果之间的关联。通过漏斗图、Egger检验和修剪填充分析评估发表偏倚。
CXL显著改善了角膜生物力学特性，特别是使用Corvis ST评估时，75%的研究检测到了变化，而使用ORA时为25%。动态参数如V1、V2和L2比标准指标更敏感。Meta回归显示，Corvis ST的角膜硬度与视力之间存在显著相关性（p分别为0.02和0.04），而ORA则无此相关性。生物力学变化的合并效应量为0.74（95%CI 0.59 - 0.89），修剪填充调整后降至0.62，表明存在16.2%的潜在发表偏倚。Egger检验证实了小样本研究效应（p = 0.024）。异质性较高（I = 98.3%），这归因于方案和研究设计的差异。
CXL可使圆锥角膜患者角膜生物力学特性得到持续改善，使用动态和特定设备指标检测效果更强且更一致，尤其是使用Corvis ST时。虽然研究结果支持CXL的长期疗效，但测量方案的差异突出了标准化的必要性。Meta回归证实了生物力学改善的临床相关性，特别是它们与视觉功能的相关性。
