ReviewCureus2026
Comparative Efficacy and Safety of Conventional Dresden, Transepithelial, and Accelerated Corneal Collagen Cross-Linking Protocols for Progressive Keratoconus: A Systematic Review.
Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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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
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Corrections and comments
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Authors and funding
1 author.
Funding
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Abstract
objectiveThe objective of this study was to compare the efficacy and safety of conventional Dresden, transepithelial (epithelium-on), and accelerated corneal collagen cross-linking (CXL) protocols for the treatment of progressive keratoconus.
methodsA systematic review of 84 studies was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Study screening and data extraction were supported by AI-assisted tools with full manual verification. Extracted outcomes included keratometric stabilization, visual acuity, endothelial cell density (ECD), complications, corneal thickness changes, and biomechanical or surrogate markers.
resultsConventional epithelium-off (epi-off) CXL demonstrated the most consistent long-term keratometric stabilization and visual acuity preservation, with mean Kmax flattening of approximately 1.0-2.3 D at 12-36 months and durability extending up to five years in long-term datasets, alongside corrected distance visual acuity improvements of approximately 0.10-0.23 logMAR. Accelerated CXL protocols achieved comparable short-term outcomes (approximately 0.8-1.5 D Kmax flattening at 6-12 months) but exhibited greater variability in durability at longer follow-up. Standard transepithelial approaches generally produced smaller effects, although enhanced epi-on protocols incorporating oxygen supplementation or modified riboflavin delivery achieved keratometric stabilization approaching epi-off outcomes in selected studies (approximately 1.5-1.7 D flattening). Across all protocols, endothelial cell density was preserved, with changes typically within physiologic variability (<5%). Transient corneal haze occurred more frequently following conventional epi-off CXL (approximately 40-70%) than accelerated protocols (approximately 20-47%), while serious complications, including infectious keratitis, remained rare (approximately 0.001-0.5%).
conclusionConventional epi-off CXL has the strongest evidence for durable keratometric stabilization and visual acuity preservation in progressive keratoconus. Accelerated protocols offer similar short-term efficacy with improved treatment efficiency, while enhanced transepithelial approaches may be appropriate for selected patients prioritizing reduced invasiveness and postoperative discomfort, with potential trade-offs in long-term durability.
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