Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis

Figures & data

Figure 1 Flow diagram of study selection.

Table 1 Baseline Characteristics of the Studies Included

Author	Year	Country	Design	Eyes	Mean Age (Years)	Male/Female	Duration (Months)
Salgado^Citation33	2011	Germany	Prospective	20	38.4 (27–51)	9/6	12 month
Li G^Citation34	2012	China	Prospective	11	27.4 (20–36)	5/6	12 month
Richoz^Citation35	2013	Switzerland	Retrospective	26	35 (23–46)	18/8	25 ± 13 month
Hallahan^Citation29	2014	United States	RCT	27	NA	17/10	3 month
Yildirim^Citation36	2014	Turkey	Retrospective	20	34 (25–45)	7/7	42 ± 7 month
Tong^Citation37	2017	Australia	Retrospective	14	NA	5/6	NA
Hersh^Citation30	2017	United States	RCT	91	NA	33/58	12 month
Khairy^Citation31	2019	Egypt	RCT	54	NA	NA	12 month
Tian^Citation38	2021	China	Prospective	25	NA	19/6	NA
Chanbour^Citation39	2021	Lebanon	Retrospective	54	NA	26/28	36 month
Nasef^Citation40	2022	Egypt	Retrospective	21	NA	3/8	24 month
Margines^Citation41	2023	United States	Prospective	82	42.8 (21–67)	NA	60 month
Rocha^Citation32	2014	Switzerland	RCT	14	NA	NA	3 month
Marino^Citation42	2015	Brazil	Prospective	40	33.8 (24–52)	15/9	24 month
Vinciguerra^Citation43	2010	Italy	Prospective	13	42 (30–59)	6/3	12 month

Abbreviations: RCT, randomized clinical trial; NA, not applicable.

Figure 2 UCVA forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslining; SMD, standardized mean difference.

Figure 3 CDVA forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 4 SE forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 5 Kmax forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 6 ISV forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 7 IVA forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 8 KI forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 9 CKI forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 10 Rmin forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 11 IHA forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 12 IHD forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 13 EEC forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 14 CCT forest plot.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking; SMD, standardized mean difference.

Figure 15 Serious Complications rates.

Abbreviations: I², heterogeneity; p, p-value; Pre-CXL, before crosslinking; Post-CXL, after crosslinking.

Salgado JP, Khoramnia R, Lohmann CP, Winkler von Mohrenfels C. Corneal collagen crosslinking in post-LASIK keratectasia. Br J Ophthalmol. 2011;95(4):493–497. doi:10.1136/bjo.2010.179424

 PubMed Web of Science ®Google Scholar

Li G, Fan ZJ, Peng XJ. Corneal collagen crosslinking for corneal ectasia of post-LASIK: one-year results. Int J Ophthalmol. 2012;5(2):190–195. doi:10.3980/j.issn.2222-3959.2012.02.15

 PubMed Web of Science ®Google Scholar

Richoz O, Mavrakanas N, Pajic B, Hafezi F. Corneal collagen cross-linking for ectasia after LASIK and photorefractive keratectomy: long-term results. Ophthalmology. 2013;120(7):1354–1359. doi:10.1016/j.ophtha.2012.12.027

 PubMed Web of Science ®Google Scholar

Hallahan KM, Rocha K, Roy AS, Randleman JB, Stulting RD, Dupps WJ. Effects of corneal cross-linking on ocular response analyzer waveform-derived variables in keratoconus and postrefractive surgery ectasia. Eye Contact Lens. 2014;40(6):339–344. doi:10.1097/ICL.0000000000000090

 PubMed Web of Science ®Google Scholar

Yildirim A, Cakir H, Kara N, et al. Corneal collagen crosslinking for ectasia after laser in situ keratomileusis: long-term results. J Cataract Refract Surg. 2014;40(10):1591–1596. doi:10.1016/j.jcrs.2014.01.042

 PubMed Web of Science ®Google Scholar

Tong JY, Viswanathan D, Hodge C, Sutton G, Chan C, Males JJ. Corneal Collagen Crosslinking for Post-LASIK Ectasia: an Australian Study. Asia Pac J Ophthalmol. 2017;6(3):228–232. doi:10.22608/APO.2016197

 PubMedGoogle Scholar

Hersh PS, Stulting RD, Muller D, Durrie DS, Rajpal RK; Group USCS. U.S. multicenter clinical trial of corneal collagen crosslinking for treatment of corneal ectasia after refractive surgery. Ophthalmology. 2017;124(10):1475–1484. doi:10.1016/j.ophtha.2017.05.036

 PubMed Web of Science ®Google Scholar

Khairy HA, Elsawy MF, Said-Ahmed K, Zaki MA, Mandour SS. Accelerated versus standard corneal cross linking in the treatment of ectasia post refractive surgery and penetrating keratoplasty: a medium term randomized trial. Int J Ophthalmol. 2019;12(11):1714–1719. doi:10.18240/ijo.2019.11.08

 PubMed Web of Science ®Google Scholar

Tian M, Zhang X, Jian W, Sun L, Shen Y, Zhou X. Long-term follow-up of accelerated transepithelial corneal crosslinking for post-LASIK Ectasia: a pilot prospective observational study. Front Bioeng Biotechnol. 2021;9:809262. doi:10.3389/fbioe.2021.809262

 PubMed Web of Science ®Google Scholar

Chanbour W, El Zein L, Younes MA, et al. corneal cross-linking for keratoconus and post-LASIK Ectasia and failure rate: a 3 years follow-up study. Cureus. 2021;13(11):e19552. doi:10.7759/cureus.19552

 PubMed Web of Science ®Google Scholar

Nasef MH, El Emam SY, Haleem TI, Shalaby WS, Allam WA. Visual and topographic outcomes of corneal collagen cross linking for post LASIK Ectasia. Clin Ophthalmol. 2022;16:2025–2032. doi:10.2147/OPTH.S370033

 PubMed Web of Science ®Google Scholar

Margines JB, Rabinowitz YS, Li X, Gaster RN. Results of corneal collagen cross-linking in patients with corneal ectasia after laser refractive surgery-A prospective study. Photodiagnosis Photodyn Ther. 2023;42:103521. doi:10.1016/j.pdpdt.2023.103521

 PubMed Web of Science ®Google Scholar

Rocha KM, Perez-Straziota CE, Stulting RD, Randleman JB. Epithelial and stromal remodeling after corneal collagen cross-linking evaluated by spectral-domain OCT. J Refract Surg. 2014;30(2):122–127. doi:10.3928/1081597X-20140120-08

 PubMed Web of Science ®Google Scholar

Marino GK, Torricelli AA, Giacomin N, Santhiago MR, Espindola R, Netto MV. Accelerated corneal collagen cross-linking for postoperative LASIK Ectasia: two-year outcomes. J Refract Surg. 2015;31(6):380–384. doi:10.3928/1081597X-20150521-04

 PubMed Web of Science ®Google Scholar

Vinciguerra P, Camesasca FI, Albe E, Trazza S. Corneal collagen cross-linking for ectasia after excimer laser refractive surgery: 1-year results. J Refract Surg. 2010;26(7):486–497. doi:10.3928/1081597X-20090910-02

 PubMed Web of Science ®Google Scholar