目的:回顾有关比较不同角膜胶原交联(CXL)方案治疗进行性圆锥角膜的疗效的科学文献。方法:系统评价CXL结局的随机临床试验(RCTs)。使用Cochrane图书馆进行了搜索,PubMed,EMBASE,WebofScience,OvidMEDLINE,和Scopus数据库。通过应用过滤器CASPe(西班牙关键评估技能计划)分析内部效度。结果:搜索产生了1151篇文章,其中,14篇文章符合定义的纳入和排除标准。常规(S)交联(CXL)比跨上皮(TE)CXL提供更好的地形结果,S-CXL对角膜扁平化的治疗效果优于加速(A)CXL。低渗性核黄素的CXL后角膜变薄程度低于核黄素-葡聚糖。虽然一项研究表明,S-CXL比A-CXL具有更好的角膜扁平化治疗效果,另一项研究显示,两种技术的结果相似。分界线深度与地形变化无相关性,这不是治疗有效性的直接衡量标准。文献的质量分析得出平均得分为8.64,表明评估的RCT具有总体可接受的质量。结论:已经进行了比较CXL技术的高质量RCT,他们中的大多数表明,epi-offCXL可以被认为是进行性圆锥角膜的标准治疗方法。TE-CXL和离子电渗辅助CXL主要用于有角膜瘢痕形成风险的患者和疼痛不耐受的患者。分别。
Purpose: To
review the scientific literature on the comparison of the efficacy of different corneal collagen crosslinking (CXL) protocols for the treatment of progressive keratoconus.Methods: Systematic
review of randomized clinical trials (RCTs) on CXL outcomes. A search was carried out using the Cochrane Library, PubMed, EMBASE, Web of Science, Ovid MEDLINE, and Scopus databases. Internal validity was analyzed by applying the filter CASPe (Critical Appraisal Skills Program Spain).Results: The search yielded 1151 articles, and among these, 14 articles met the inclusion and exclusion criteria defined. Conventional (S) crosslinking (CXL) provided better topographic outcomes than transepithelial (TE) CXL, and S-CXL had a better therapeutic effect of corneal flattening than accelerated (A) CXL. The corneal thinning after CXL was lower with hypotonic riboflavin than with riboflavin-dextran. While one study demonstrated a better therapeutic effect of corneal flattening with S-CXL than with A-CXL, another study showed similar results between both techniques. No correlation was found between the depth of the demarcation line and topographic changes, which was not a direct measure of treatment effectiveness. Quality analysis of the literature reviewed yielded a mean score of 8.64, indicating that the RCTs evaluated had an overall acceptable quality.Conclusions: Good-quality RCTs comparing CXL techniques have been conducted, and most of them suggest that epi-off CXL can be considered the standard treatment for progressive keratoconus. TE-CXL and iontophoresis-assisted CXL are mainly indicated in patients with a risk of corneal scarring and patients with pain intolerance, respectively.