ReviewClinical ophthalmology (Auckland, N.Z.)2025
Efficacy and Safety of Epi-On vs Epi-Off Corneal Cross-Linking in Corneal Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Review in Clinical ophthalmology (Auckland, N.Z.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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
6 citing papers in PubMed.
- The Critical Role of Oxygen Supplementation in Epithelium-On Corneal Cross-Linking: A Narrative Review.Advances in therapy · 2026Review
- Safety and efficacy of contact lens-assisted accelerated corneal cross-linking using Nelfilcon A in thin corneas.International ophthalmology · 2026Article
- Transepithelial corneal cross-linking: a review.International ophthalmology · 2026Review
- 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
- Interventional Keratoconus Management: The Critical Imperative for Early Detection and Treatment.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
- Ten Years' Experience Using Proxymetacaine Hydrochloride 0.5% for Postoperative Pain Control in Epithelium-Off Corneal Crosslinking.Journal of clinical medicine · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Corneal ectasias are progressive conditions that impair vision and quality of life. Corneal collagen cross-linking (CXL) aims to halt disease progression by strengthening the cornea. This review compares two CXL methods, epithelium-on (epi-on) and epithelium-off (epi-off), to assess their safety and effectiveness for managing corneal ectasia. A systematic search up to July 2024 of PubMed, Medline, Web of Science, Cochrane Central, Google Scholar, and Scopus identified 13 randomized controlled trials (RCTs) involving 872 patients and 1041 eyes. Data were analyzed following PRISMA guidelines using fixed-effects and random-effects models. The primary outcome was the change in maximal keratometry (Kmax) at 12 months, with secondary outcomes including safety profile, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), spherical equivalent (SE), and endothelial cell count (ECC). The findings revealed no statistically significant differences between epithelium-on (epi-on) and epithelium-off (epi-off) CXL in Kmax, BCVA, UCVA, SE, or corneal curvature parameters. However, epithelium-off (epi-off) CXL was associated with less endothelial cell loss and higher rates of side effects, including corneal haze and postoperative discomfort. The choice of treatment should be tailored to individual patient needs, balancing clinical goals and safety considerations. This review highlights the need for further studies to optimize CXL approaches and improve outcomes while minimizing complications.
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.