SynthesisInternational ophthalmology2026
Timing of corneal cross-linking in eyes undergoing intracorneal ring segments for keratoconus: same-day versus staged CXL: a systematic review and meta-analysis.
Synthesis in International ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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4 authors.
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Abstract
backgroundIn keratoconus managed with intracorneal ring segments (ICRS) plus corneal cross-linking (CXL), ICRS primarily reshapes the cornea while CXL provides biomechanical improvement and shape stabilization. However, clinical practice varies regarding whether CXL should be performed on the same day as ICRS or delayed, and it remains uncertain whether CXL timing modifies the postoperative optical and topographic outcomes of ICRS.
methodsWe systematically searched PubMed, Web of Science, Scopus, and the Cochrane Library from inception to October 2025 and included seven comparative studies (2010-2025; 2 randomized trials, 5 cohorts) comparing same-day ICRS + CXL versus staged (typically CXL 3-6 months later). Outcomes covered ΔCDVA/ΔUDVA (logMAR), refractive cylinder and spherical equivalent (SE), keratometry (Kmax, K1, K2, Km), and adverse events; Common-effect models summarized pooled effects.
resultsVisual acuity improvements were equivalent between strategies with no heterogeneity (I
conclusionsSame-day and staged ICRS + CXL provide similar gains in vision and refraction with comparable safety at 6-12 months, addressing short-term outcome differences attributable to CXL timing rather than progression control. Small keratometric signals favoring simultaneous surgery are not conclusive. Either strategy is reasonable; larger, well-designed randomized trials with longer follow-up should test whether subtle keratometric differences translate into superior long-term stability.
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