Cochrane · systematic review · CD013512
Transepithelial versus epithelium‐off corneal crosslinking for progressive keratoconus
Ng, SM, Ren, M, Lindsley, KB, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Eyes and VisionAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
16
current version
GRADE rated
14
No studies
2
Included studies
NR
No studies 2 · 12.5%Ungraded 0 · 0%Very low 11 · 68.8%Low 2 · 12.5%Moderate 1 · 6.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Transepithelial CXL compared with epithelium‐off CXL for progressive keratoconus
Population: participants with keratoconus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean change in maximum K from baseline or final value—at 12 months or more (diopters) Transepithelial CXL vs epithelium‐off CXL | no estimate extracted | 5 studies · 177 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants whose maximum K decreased by at least 2 diopters—at 12 months Transepithelial CXL vs epithelium‐off CXL | RR 0.32 [0.09, 1.12] | 1 study · 61 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants whose maximum K increased by at least 2 diopters—at 12 months Transepithelial CXL vs epithelium‐off CXL | no estimate extracted | 1 study · 61 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants whose keratoconus remained stable—at 12 months Transepithelial CXL vs epithelium‐off CXL | no estimate extracted | 2 studies · 131 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Mean change in corrected distance visual acuity (logMAR) from baseline or final values—at 12 months or more Transepithelial CXL vs epithelium‐off CXL | no estimate extracted | 4 studies · 137 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants who gained 10 or more logMAR letters from baseline Transepithelial CXL vs epithelium‐off CXL | no estimate extracted | NR | No studies |
Proportion of participants who lost 10 or more logMAR letters from baseline Transepithelial CXL vs epithelium‐off CXL | no estimate extracted | NR | No studies |
Adverse outcomes—corneal haze or scarring Transepithelial CXL vs epithelium‐off CXL | no estimate extracted | 4 studies · 221 participants | Moderate Downgraded: risk of bias |
Transepithelial CXL using iontophoresis compared with epithelium‐off CXL for progressive keratoconus
Population: participants with progressive keratoconus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean change in maximum K from baseline or final value—at 12 months or more (diopters) Transepithelial CXL using iontophoresis vs epithelium‐off CXL | no estimate extracted | 2 studies · 51 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants whose maximum K decreased by at least 2 diopters—at 24 months Transepithelial CXL using iontophoresis vs epithelium‐off CXL | no estimate extracted | 1 study · 31 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants whose maximum K increased by at least 2 diopters—at 24 months Transepithelial CXL using iontophoresis vs epithelium‐off CXL | no estimate extracted | 1 study · 31 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants whose keratoconus remained stable—at 24 months Transepithelial CXL using iontophoresis vs epithelium‐off CXL | RR 0.92 [0.76, 1.12] | 1 study · 31 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Mean change in corrected distance visual acuity (logMAR) from baseline or final values at 12 months or more Transepithelial CXL using iontophoresis vs epithelium‐off CXL | no estimate extracted | 2 studies · 51 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants who gained 10 or more logMAR letters from baseline Transepithelial CXL using iontophoresis vs epithelium‐off CXL | RR 2.73 [0.36, 20.74] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Proportion of participants who lost 10 or more logMAR letters from baseline Transepithelial CXL using iontophoresis vs epithelium‐off CXL | RR 1 [0.88, 1.13] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse outcomes Transepithelial CXL using iontophoresis vs epithelium‐off CXL | no estimate extracted | 3 studies · 203 participants | Low Downgraded: risk of bias, imprecision, inconsistency |