SynthesisAmerican journal of ophthalmology2021
Transepithelial Versus Epithelium-Off Corneal Crosslinking for Progressive Keratoconus: Findings From a Cochrane Systematic Review.
Synthesis in American journal of ophthalmology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Comparison of Efficacy and Safety Between Standard, Accelerated Epithelium-Off and Transepithelial Corneal Collagen Crosslinking in Pediatric Keratoconus: A Meta-Analysis.Frontiers in medicine · 2022Pooled it
- A randomised controlled trial on cross-linking protocols for the treatment of progressive keratoconus using isoosmolar and hypoosmolar riboflavin with the addition of sterile water in thin corneae.Acta ophthalmologica · 2026Trial
- Early findings in a randomised controlled trial on crosslinking protocols using isoosmolar and hypoosmolar riboflavin for the treatment of progressive keratoconus.Acta ophthalmologica · 2025Trial
- Early findings in a prospective randomised study on three cross-linking treatment protocols: interruption of the iontophoresis treatment protocol.BMJ open ophthalmology · 2023Trial
- Obesity and Keratoconus: A Mediation Study Based on the Chinese Keratoconus Cohort.Translational vision science & technology · 2026Article
- Vision-Related Quality of Life in Iraqi Keratoconus Patients: A Comparative Analysis of Surgical and Nonsurgical Interventions.Korean journal of ophthalmology : KJO · 2026Article
- The Future of Interventional Keratoconus Management: Perspectives on Integrating Epithelium-on Oxygen-Enriched Cross-Linking into Comprehensive Care Pathways.Therapeutics and clinical risk management · 2026Article
- Precise Epithelium Removal for Ectatic Corneas Technique in Corneal Collagen Crosslinking (PERFECT-CXL): Technique Description and Clinical Outcomes.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
- Interventional Keratoconus Management: The Critical Imperative for Early Detection and Treatment.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
- The microenvironment of ocular surface in keratoconus: a systematic review.Eye and vision (London, England) · 2025Review
- Diurnal Variations in Anterior Segment Parameters in Different Grades of Patients With Keratoconus.Translational vision science & technology · 2025Article
- Reproducibility and Screening Capability of Corneal Epithelial Thickness Measurement for Keratoconus Using Anterior Segment Optical Coherence Tomography.Clinical ophthalmology (Auckland, N.Z.) · 2025Article
- Mediating roles of corneal biomechanical and topographic parameters in eye rubbing and keratoconus based on the Chinese keratoconus cohort study.Frontiers in bioengineering and biotechnology · 2025Article
- Prediction model for treatment outcomes 3 years after corneal cross-linking for keratoconus.International ophthalmology · 2024Article
- Patient experience and repeatability of measurements made with the Pentacam HR in patients with keratoconus.BMC ophthalmology · 2023Article
- Current clinical practice in corneal crosslinking for treatment of progressive keratoconus in four Nordic countries.Acta ophthalmologica · 2023Article
- Non-antibiotic management of bacterial keratitis.Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological SocietyArticle
- A comprehensive review on corneal crosslinking.Taiwan journal of ophthalmologyReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
purposeThe purpose of this study was to summarize key findings from a systematic review of the effectiveness and safety of transepithelial corneal crosslinking (CXL) compared with epithelium-off CXL for progressive keratoconus.
designCochrane systematic review.
methodsWe included in our review only randomized controlled trials (RCTs) in which transepithelial and epithelium-off CXL had been compared among participants with progressive keratoconus. The primary outcome was keratoconus stabilization based on post-operative maximum keratometry (Kmax). We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis.
resultsThirteen RCTs with 567 participants (661 eyes) were included; 11 studies compared non-iontophoresis-assisted transepithelial with epithelium-off CXL. Keratoconus stabilization was described as an outcome in 2 studies. The estimated difference in Kmax means (ie, the "mean difference," MD) from meta-analysis of 177 eyes in 5 RCTs indicated that there were no differences between intervention groups in Kmax at 12 months or later (MD: 0.99 diopter [D]; 95% confidence interval: -0.11 to 2.09). Meta-analysis of keratometry and visual acuity outcomes at 12 months or longer after surgery from 2 studies that had compared transepithelial CXL using iontophoresis provided no conclusive evidence of an advantage over epithelium-off CXL.
conclusionsLack of precision due to small sample sizes, indeterminate risk of bias due to inadequate reporting, and inconsistency in how outcomes were measured and reported among studies make it difficult to state with confidence whether transepithelial CXL confers an advantage over epithelium-off CXL for patients with progressive keratoconus with respect to stabilization of keratoconus, visual acuity, or patient-reported outcomes based on available data.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.