Comparison of refractive surgeries (SMILE, LASIK, and PRK) with and without corneal crosslinking: systematic review and meta-analysis.

J Cataract Refract Surg

From the FMH College of Medicine & Dentistry, Lahore, Pakistan (Hira); Federal University of Pelotas, Pelotas, Brazil (Klein Heffel); Department of Ophthalmology, Fatima Memorial Hospital, Lahore, Pakistan (Mehmood); Teerthanker Mahaveer University, Moradabad, UP, India (Sehgal); City University of São Paulo, São Paulo, Brazil (Felix De Farias Santos); University of Iowa, Iowa City, Iowa (Steuernagel Del Valle).

Published: May 2024

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Article Abstract

Corneal crosslinking (CXL) is used for treating keratoconus and post-laser in situ keratomileusis ectasia. However, refractive surgery is not usually performed with prophylactic CXL. Therefore, we performed a meta-analysis comparing outcomes of refractive surgeries with vs without prophylactic CXL. We systematically searched databases for studies comparing refractive surgeries for myopic correction with vs without prophylactic corneal crosslinking. Review Manager 5.4.1 was used to perform statistical analysis. We included 2820 eyes from 28 studies. Compared with refractive surgery alone, surgery with prophylactic CXL resulted in decreased central corneal thickness, corrected distance visual acuity logMAR, and safety and efficacy indices. There were no significant differences in postoperative uncorrected distance visual acuity of 20/20 or better at ≥12 months and other visual outcomes among both groups. More randomized controlled trials with standard crosslinking protocols are needed to analyze the prophylactic use of crosslinking with refractive surgeries.

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http://dx.doi.org/10.1097/j.jcrs.0000000000001405DOI Listing

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