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Abstract：
OBJECTIVE: Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to compare the efficacy and safety of epithelium-on versus epithelium-off CXL to treat keratoconus.
METHODS: We searched PubMed, Medline, Embase, Web of Science, and Scopus databases. We included studies that compared standard epithelium-off with epithelium-on CXL. The primary outcome measures were changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax), and the secondary outcomes were uncorrected distance visual acuity (UDVA), central corneal thickness (CCT), and adverse events. A meta-analysis was performed on the primary and secondary outcomes based on the weighted mean differences between baseline to 12-month follow-up.
RESULTS: The search retrieved 887 publications with 27 included in the systematic review. A total of 1622 eyes (1399 patients; age 25.51 ± 4.02 years) were included in comparisons of epithelium-off to epithelium-on CXL in keratoconus. Epithelium-off CXL treated 800 eyes and epithelium-on CXL for 822 eyes. At 12-month follow-up, CDVA and Kmax showed no significant difference between the epithelium-off and epithelium-on CXL. The secondary outcomes showed that UDVA was better in epithelium-off CXL (- 0.11D, 95% CI - 0.12, - 0.1; p < 0.001) and there was more thinning in CCT in epithelium-off CXL (- 3.23 μm, 95% CI - 4.64, - 1.81; p <0.001).
CONCLUSIONS: Epithelium-off and epithelium-on CXL were both effective to treat progressive keratoconus. Further research is needed to compare the long-term outcomes and safety of both CXL protocols for adaptation into clinical practice.
METHODS: We searched PubMed, Medline, Embase, Web of Science, and Scopus databases. We included studies that compared standard epithelium-off with epithelium-on CXL. The primary outcome measures were changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax), and the secondary outcomes were uncorrected distance visual acuity (UDVA), central corneal thickness (CCT), and adverse events. A meta-analysis was performed on the primary and secondary outcomes based on the weighted mean differences between baseline to 12-month follow-up.
RESULTS: The search retrieved 887 publications with 27 included in the systematic review. A total of 1622 eyes (1399 patients; age 25.51 ± 4.02 years) were included in comparisons of epithelium-off to epithelium-on CXL in keratoconus. Epithelium-off CXL treated 800 eyes and epithelium-on CXL for 822 eyes. At 12-month follow-up, CDVA and Kmax showed no significant difference between the epithelium-off and epithelium-on CXL. The secondary outcomes showed that UDVA was better in epithelium-off CXL (- 0.11D, 95% CI - 0.12, - 0.1; p < 0.001) and there was more thinning in CCT in epithelium-off CXL (- 3.23 μm, 95% CI - 4.64, - 1.81; p <0.001).
CONCLUSIONS: Epithelium-off and epithelium-on CXL were both effective to treat progressive keratoconus. Further research is needed to compare the long-term outcomes and safety of both CXL protocols for adaptation into clinical practice.
摘要：
目的：角膜胶原交联（CXL）是进行性圆锥角膜的主要治疗方法，对视力和生活质量有重要影响。我们的研究旨在比较上皮上和上皮外CXL治疗圆锥角膜的疗效和安全性。
方法：我们搜索了PubMed，Medline,Embase,WebofScience,和Scopus数据库。我们纳入了比较标准上皮脱落与CXL上皮的研究。主要结局指标是矫正视力（CDVA）和最大角膜曲率（Kmax）的变化，次要结局是未矫正视力（UDVA），中央角膜厚度(CCT),和不良事件。基于基线至12个月随访之间的加权平均差异，对主要和次要结局进行了荟萃分析。
结果：搜索检索到887篇出版物，其中27篇纳入系统评价。共有1622只眼（1399例患者；年龄25.51±4.02岁）被纳入圆锥角膜CXL上皮脱落与上皮的比较。上皮外CXL治疗800只眼，上皮外CXL治疗822只眼。在12个月的随访中，CDVA和Kmax在CXL上上皮和上皮之间没有显着差异。次要结果显示，在上皮外CXL中，UDVA更好（-0.11D，95％CI-0.12，-0.1；p<0.001），上皮外CXL的CCT变薄（-3.23μm，95%CI-4.64，-1.81；p<0.001)。
结论：上皮脱落和CXL上上皮均可有效治疗进行性圆锥角膜。需要进一步的研究来比较两种CXL方案适应临床实践的长期结果和安全性。
方法：我们搜索了PubMed，Medline,Embase,WebofScience,和Scopus数据库。我们纳入了比较标准上皮脱落与CXL上皮的研究。主要结局指标是矫正视力（CDVA）和最大角膜曲率（Kmax）的变化，次要结局是未矫正视力（UDVA），中央角膜厚度(CCT),和不良事件。基于基线至12个月随访之间的加权平均差异，对主要和次要结局进行了荟萃分析。
结果：搜索检索到887篇出版物，其中27篇纳入系统评价。共有1622只眼（1399例患者；年龄25.51±4.02岁）被纳入圆锥角膜CXL上皮脱落与上皮的比较。上皮外CXL治疗800只眼，上皮外CXL治疗822只眼。在12个月的随访中，CDVA和Kmax在CXL上上皮和上皮之间没有显着差异。次要结果显示，在上皮外CXL中，UDVA更好（-0.11D，95％CI-0.12，-0.1；p<0.001），上皮外CXL的CCT变薄（-3.23μm，95%CI-4.64，-1.81；p<0.001)。
结论：上皮脱落和CXL上上皮均可有效治疗进行性圆锥角膜。需要进一步的研究来比较两种CXL方案适应临床实践的长期结果和安全性。
