ReviewGraefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie2026
Evaluating the rationale and outcomes of crosslinking corneal stromal lenticules: a systematic review with exploratory pooled analysis.
Review in Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 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
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo systematically evaluate the biomechanical, optical, and clinical outcomes of crosslinking (CXL) applied to corneal stromal lenticules derived from keratorefractive lenticular extraction, and to assess the rationale and efficacy of this approach for therapeutic re-implantation in corneal disease.
methodsA systematic review with exploratory pooled analysis was conducted following PRISMA and MOOSE guidelines. Literature searches across five databases identified studies reporting outcomes following crosslinking of SMILE-derived lenticules. Risk of bias was assessed using appropriate tools for study design. Random-effects pooled analyses were performed for clinical outcomes where appropriate, with careful consideration of study heterogeneity.
resultsNine studies met inclusion criteria (5 in vitro, 4 clinical). In vitro studies consistently demonstrated that both ultraviolet A (UVA)-riboflavin and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide/N-hydroxysuccinimide (EDC/NHS) chemical CXL enhanced lenticule stiffness, enzymatic resistance, and transparency, with chemical CXL showing superior mechanical performance. Because of the limited sample size and substantial between-study heterogeneity, pooled estimates should be interpreted as exploratory and hypothesis-generating rather than definitive evidence. Clinical data from 26 eyes across three heterogeneous studies showed variable outcomes. Maximum keratometry showed a non-significant trend toward improvement (random-effects weighted mean difference: -2.94 D; 95% CI: -6.24 to 0.35 D; P = 0.08), though this finding was limited by substantial heterogeneity (I² = 87.7%). No serious complications were reported in the limited follow-up periods available.
conclusionsIn vitro experimental studies consistently demonstrate that crosslinking enhances the structural resilience and therapeutic potential of SMILE-derived lenticules. Chemical CXL, particularly EDC/NHS protocols, provides superior biomechanical reinforcement while preserving transparency in experimental settings. Preliminary clinical data suggest possible benefit in selected advanced keratoconus cases. However, current evidence remains insufficient to establish efficacy. Controlled trials are warranted to standardize protocols and validate long-term safety and efficacy.
Indexed as
Identifiers
42541559What 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.