Accelerated versus conventional corneal collagen cross-linking for keratoconus: A meta-analysis of randomized controlled trials

source extracted confidence: high 2026-04-09
#humans #keratoconus #cross-linking-reagents #collagen #randomized-controlled-trials-as-topic

Accelerated versus conventional corneal collagen cross-linking for keratoconus: A meta-analysis of randomized controlled trials

Yeh et al., 2025 | Eur J Ophthalmol | Meta Analysis

Citation

Yeh Cyuan Yi, Chen Kuan Chieh, ... Cheng Sheng Fu. Accelerated versus conventional corneal collagen cross-linking for keratoconus: A meta-analysis of randomized controlled trials. Eur J Ophthalmol. 2025-May;35(3):785-798. doi:10.1177/11206721241298317

Abstract

PurposeTo systematically compare the effectiveness of conventional corneal collagen cross-linking (CCXL) protocols and accelerated corneal collagen cross-linking (ACXL) protocols in cases with progressive keratoconus.MethodsThe Cochrane library, EMBASE, MEDLINE, PubMed, and Web of Science databases were searched for randomized controlled trials (RCTs). Outcomes were clinical results and changes in corneal properties. Standardized mean differences (SMD) and 95% confidence interval (CI) were used to estimate the clinical consequences. All outcomes were distributed by different follow-up durations (6 months, 12 months, and > 12 months). We also compared maximum keratometry (Kmax) and best spectacle-corrected visual acuity (BCVA) in subgroups, which were categorized by the discrepant impregnation time period of riboflavin.ResultsWe included 14 RCTs that met the eligibility criteria in this meta-analysis. At the last follow-up, CCXL was superior in postoperative change in demarcation line (SMD: -1.573; 95% CI: -2.897 to -0.248) and in Kmax (SMD:0.302; 95% CI: 0.071 to 0.533), whereas ACXL provided a significantly lower reduction in central corneal thickness (SMD: 0.498; 95% CI: 0.125 to 0.871). No differences in the changes in uncorrected visual acuity, BCVA, manifest refraction spherical equivalent, corneal biomechanical properties, and the endothelial cell density were found among both groups.ConclusionCCXL was superior to ACXL in greater corneal flattening and deeper demarcation line, while ACXL seemed to cause less reduction in CCT and allow for earlier UDVA stability. To clearly define the comparative safety and clinical consequences of the different regimens of CXL, more RCTs are required.

Key Findings

To clearly define the comparative safety and clinical consequences of the different regimens of CXL, more RCTs are required.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 14
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Keratoconus
  • Cross-Linking Reagents
  • Collagen
  • Randomized Controlled Trials as Topic
  • Photosensitizing Agents
  • Photochemotherapy
  • Riboflavin
  • Visual Acuity
  • Ultraviolet Rays
  • Corneal Stroma
  • Corneal Cross-Linking

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Review, Comparative Study
  • Vertical: collagen

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09