Table 1 Characteristics of the 15 studies included in the review
Authors, year | Country | Design | Population/Sample size | Comparison | Epi-on CXL protocol | Outcomes measures | Follow-up |
|---|---|---|---|---|---|---|---|
Vinciguerra et al. 2019 [47] | Italy | Prospective comparative non-randomized clinical study | Adult with progressive keratoconuss /n = 60 | 20 S-CXL 20 I-CXL 20 I-SCXL | I-CXL: Constant current set at 1 mA for 5 min, Ricrolin + , UVA 10 mW/cm2 for 9 min | CDVA, refraction, topography, HOAs, pachymetry, ECD | 24 months |
Lombardo et al. 2019 [48] | Italy | Prospective unmasked randomized controlled trial | Adult with progressive keratoconus / n = 34 | 12 standard CXL 22 T-ionto CXL | T-ionto CXL: Current intensity set at 1.0 mA for 5 min, Ricrolin + , UVA 10 mW/cm2 for 9 min | UDVA, CDVA, refraction, contrast sensitivity, topography ECD, pachymetry, HOAs | 24 months |
Al Zubi et al. 2019 [49] | Jordan | Randomized control trial | Adult with progressive keratoconus / n = 80 | 40 epi-off CXL 40 transepithelial CXL | Transepithelial CXL: 0.1% riboflavin in 20% dextran for 30 min, UVA 3 mW/ cm2 for 30 min | UDVA, CDVA, pachymetry, topography | 12 months |
Iqbal et al. 2019 [50] | Egypt | Prospective multicenter controlled trial | Pediatric with progressive keratoconus / n = 271 | 91 S-CXL 92 A-CXL 88 T-CXL | T-CXL: 0.25% riboflavin, benzalkonium chloride and hydroxypropyl methylcellulose for 4.5 min, riboflavin 0.22% for 6 min, UVA 45 mW/cm2 for 5:20 min (pulsed) | UDVA, CDVA, refraction, topography, pachymetry | 24 months |
Rossi et al. 2018 [51] | Italy | Prospective clinical study | Adult with progressive keratoconus / n = 30 | 10 epi-off CXL 10 epi-on CXL 10 I-CXL | Epi-on CXL: Ricrolin TE for 30 min, UVA 3 mW/ cm2 for 30 min I-CXL: Current intensity set at 1.0 mA for 5 min, Ricrolin + , UVA 10 mW/cm2 for 10 min | UDVA, CDVA, refraction, topography, HOAs, pachymetry, ECD | 12 months |
Jouve et al. 2017 [52] | France | Prospective observational non-randomized clinical study | Adult with progressive keratoconus / n = 80 | 40 C-CXL 40 I-CXL | I-CXL: Current intensity set at 1.0 mA for 5 min, Ricrolin + , UVA 10 mW/cm2 for 9 min | CDVA, topography, pachymetry, confocal microscopy, demarcation line depth | 24 months |
Henriquez et al. 2017 [53] | Peru | Prospective cohort study | Pediatric with progressive keratoconus / n = 61 | 25 epi-off CXL 36 A-epi-on CXL | A-epi-on CXL: 0.25% riboflavin with 1.0% phosphate hydroxypropyl methylcellulose with 0.007% benzalkonium chloride for 30 min, UVA 18 mW/cm2 for 5 min | UCVA, BCVA, refraction, pachymetry, topography | 12 months |
Godefrooij et al. 2017 [54] | Netherlands | Noninferiority randomized clinical trial | Adult with progressive keratoconus / n = 61 | 26 epi-off CXL 35 transepithelial CXL | Transepithelial CXL: Ricrolin TE for 30 min, UVA 3 mW/ cm2 for 30 min | UDVA, CDVA, refraction, HOAs, topography, pachymetry, ECD, demarcation line depth | 12 months |
Rush et al. 2017 [55] | USA | Prospective randomized controlled clinical trial | Adult with progressive keratoconus / n = 144 | 64 epi-off CXL 80 transepithelial CXL | Transepithelial CXL: Riboflavin 0.25%, hydroxypropyl methylcellulose 1.2% and benzalkonium chloride 0.01% for 30 min, UVA 3 mW/ cm2 for 30 min | BCVA, topography, pachymetry | 24 months |
Eraslan et al. 2017 [56] | Turkey | Prospective comparative non-randomized interventional study | Pediatric with progressive keratoconus / n = 36 | 18 epi-off CXL 18 epi-on CXL | Epi-on CXL: 0.25% riboflavin, 1.2% hydroxypropyl methylcellulose and 0.01% benzalkonium chloride for 30 min, UVA 3 mW/cm2 for 30 min | UDVA, CDVA, topography, HOAs, pachymetry, demarcation line depth | 24 months |
Bikbova et al. 2016 [57] | Russia | Randomized controlled clinical study | Adult with progressive keratoconus / n = 149 | 73 standard CXL 76 transepithelial CXL | Transepithelial CXL: Current intensity gradually increased from 0.2 to 1.0 mA for 10 min, Riboflavin 0.1%, UVA 3 mW/cm2 for 30 min | UDVA, CDVA, keratometry, topography, pachymetry, demarcation line depth, confocal microscopy | 24 months |
Vinciguerra et al. 2016 [58] | Italy | Prospective comparative non-randomized interventional study | Adult with progressive keratoconus / n = 40 | 20 S-CXL 20 I-CXL | I-CXL: Constant current set at 1 mA for 5 min, Ricrolin, UVA 10 mW/cm2 for 9 min | CDVA, refraction, topography, HOAs, pachymetry, ECD | 12 months |
Al Fayez et al. 2015 [59] | Saudi Arabia | Prospective randomized parallel-group trial | Adult with progressive keratoconus / n = 70 | 36 epi-off CXL 34 transepithelial CXL | Transepithelial CXL: Tetracaine 1% with benzalkonium chloride 0.02% every 2 min for 30 min, UVA 3 mW/cm2 for 30 min | UDVA, CDVA, pachymetry, ECD, topography, IOP | 36 months |
Rossi et al. 2015 [60] | Italy | Noninferiority randomized clinical trial | Adult with progressive keratoconus/ n = 20 | 10 epi-off CXL 10 transepithelial CXL | Transepithelial CXL: Ricrolin TE for 30 min, UVA 3 mW/ cm2 for 30 min | UDVA, CDVA, refraction, topography, HOAs, CCT, ECD | 12 months |
Soeters et al. 2015 [61] | Netherlands | Noninferiority randomized clinical trial | Adult with progressive keratoconus / n = 61 | 26 epi-off CXL 35 transepithelial CXL | Transepithelial CXL: Ricrolin TE for 30 min, UVA 3 mW/ cm2 for 30 min | UDVA, CDVA, refraction, topography, pachymetry, ECD, demarcation line depth | 12 months |