Conventional and transepithelial corneal cross-linking for patients with keratoconus.
Conventional and transepithelial corneal cross-linking for patients with keratoconus.
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圆锥角膜患者的传统角膜交联术和跨上皮角膜交联术
DOI：
10.1371/journal.pone.0195105
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Zhou X
中科院分区：
文献类型：
--
作者：
Zhang X;Zhao J;Li M;Tian M;Shen Y;Zhou X
以往研究传统角膜胶原交联（CXL）和经上皮CXL在圆锥角膜治疗中的有效性报告了相互矛盾的结果。因此，我们进行了一项荟萃分析，以比较这些治疗的有效性。我们检索了MEDLINE、EMBASE和科克伦对照试验中心注册系统，以查找无限制的前瞻性随机对照试验（RCT）。我们将视力（矫正远视力、未矫正远视力）和角膜曲率（K）作为主要结局参数，将等效球镜、中央角膜厚度（CCT）和内皮细胞密度作为次要参数。我们最终纳入了7份报告（包括6项RCT，涉及305名参与者和344只眼）。我们的分析显示，常规和经上皮CXL治疗患者的平均K和CCT值存在显著术后差异[K：加权平均差异（WMD）= 0.79，95%置信区间（CI）= 0.04-1.53，p = 0.04; CCT：WMD = 4.53，95% CI = 0.42-8.64，p = 0.03]。相比之下，我们没有发现组间视力、最平K值、最陡K值、柱镜K值、顶点K值、等效球镜或内皮细胞密度的任何显著差异。总之，经上皮CXL比传统CXL对角膜厚度具有更大的保护作用，并导致术后角膜扁平化程度更低。需要进一步研究经上皮CXL的临床结局。
Previous studies investigating the effectiveness of conventional corneal collagen cross-linking (CXL) and transepithelial CXL in keratoconus treatment have reported conflicting outcomes. Therefore, we conducted a meta-analysis to compare the effectiveness of these treatments. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for prospective randomized controlled trials (RCTs) with no restrictions. We included visual acuity (corrected distance visual acuity, uncorrected distance visual acuity) and corneal keratometry (K) as primary outcome parameters, and spherical equivalent, central corneal thickness (CCT), and endothelial cell density, as secondary parameters. We finally included seven reports (including six RCTs involving 305 participants and 344 eyes). Our analysis revealed significant postoperative differences in average K and CCT values between conventional and transepithelial CXL-treated patients [K: weighted mean difference (WMD) = 0.79, 95% confidence interval (CI) = 0.04–1.53, p = 0.04; CCT: WMD = 4.53, 95% CI = 0.42–8.64, p = 0.03]. In contrast, we did not find any significant differences in visual acuity, flattest K value, steepest K value, cylinder K value, apex K value, spherical equivalent, or endothelial cell density between groups. In conclusion, transepithelial CXL has a more protective influence on corneal thickness than conventional CXL, and results in lesser postoperative corneal flattening. Further investigation of the clinical outcomes of transepithelial CXL is required.
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