Research Article

Comparison of Standard and Transepithelial Corneal Cross-Linking for the Treatment of Keratoconus: A Meta-analysis

Table 1

Characteristics of the included trials.

First authorYearCountryStudy designGroupNumber of eyesMean age (year)Follow-up (months)UVA irradiation dose (mW/cm2) time (min)UVA cumulative dose (J/cm2)Riboflavin concentration (%)Riboflavin before irradiationRiboflavin during irradiation

Akbar [13]2017ArabiaNon-RCTSCXL
TECXL
32
32
24.81
24.47
183/30
3/30
5.4
5.4
0.1
0.25
With HPMC every 2 min for 20 min
With BAC and HPMC one drop every 5s till corneal thickness reached 400u
Every 2 min
Every 2 min
Bikbova [15]2016RussiaRCTSCXL
TECXL
73
76
30.00
28.00
243/30
3/30
5.4
5.4
0.1
0.1
With 20% dextran for 30 min
With iontophoresis for 10 min
Every 2 min
Every 2 min
Cifariello [14]2018ItalyRCTSCXL
TECXL
20
20
24.00
31.00
243/30
3/30
5.4
5.4
0.1
0.1
With 20% dextran every 2 min for 30 min
With ricrolin TE every 5 min for 30 min
Every 2 min
NR
Jouve [20]2017FranceNon-RCTSCXL
TECXL
40
40
26.2
26.2
243/30
10/9
54.
5.4
0.1
0.1
With 20% dextran every 2 min for 20 min
With iontophoresis (ricrolin+) for 5 min
Every 5 min
Kocak [21]2014TurkeyNon-RCTSCXL
TECXL
19
17
27.16
27.35
123/30
3/30
5.4
5.4
0.1
0.1
With 20% dextran every 2 min for 30 min
With ricrolin TE every 2 min for 30 min
Every 2 min
Every 2 min
Lombardo a [22]2016ItalyRCTSCXL
TECXL
12
22
31.05
29.4
63/30
10/9
5.4
5.4
0.1
0.1
With 20% dextran every 3 min for 30 min
With iontophoresis (ricrolin+) for 5 min
Every 3 min
Lombardo b [23]2017ItalyRCTSCXL
TECXL
12
22
31.05
29.4
123/30
10/9
5.4
5.4
0.1
0.1
With 20% dextran every 3 min for 30 min
With iontophoresis (ricrolin+) for 5 min
Every 3 min
Lombardo c [24]2019ItalyRCTSCXL
TECXL
12
22
31.05
29.4
243/30
10/9
5.4
5.4
0.1
0.1
With 20% dextran every 3 min for 30 min
With iontophoresis (ricrolin+) for 5 min
Every 3 min
Madeira [25]2019PortugalNon-RCTSCXL
TECXl
10
16
18.69
21.90
123/30
6/15
5.4
5.4
0.10.1% riboflavin preparation every 2 minutes for 30 minutes
0.25% TE riboflavin preparation every 2 minutes for 20 minutes
Every 5 min
Every 5 min
Mastropasqua [26]2013ItalyRCTSCXL
TECXL
20
20
23.00
23.00
123/30
3/30
5.4
5.4
0.1
0.1
With 20% dextran every 3 min for 15 min
With 20% dextran every 3-5 min for 30 min
Every 3 min
Every 3 min
Nawaz [27]2015IndiaRCTSCXL
TECXl
20
20
23.95
22.35
63/30
3/30
5.4
5.4
0.1
0.1
With 20% dextran every 3–5 min for 30 min
With 20% dextran every 3–5 min for 30 min
Every 3–5 min
Every 3–5 min
Rossi [28]2015ItalyRCTSCXL
TECXL
10
10
30.40
28.00
123/30
3/30
5.4
5.4
0.1
0.1
With 20% dextran every 2 min for 30 min
With ricrolin TE every 5 min for 30 min
Every 2 min
Every 5 min
Rossi a [29]2018ItalyRCTSCXL
TECXl
10
10
30.40
27.20
123/30
3/30
5.4
5.4
0.1
0.1
With 20% dextran every 2 min for 30 min
With ricrolin TE every 5 min for 30 min
Every 2 min
Every 5 min
Rossi b [29]2018ItalyRCTSCXL
TECXl
10
10
30.40
28.00
123/30
10/10
5.4
NR
0.1
0.1
With 20% dextran every 2 min for 30 min
With iontophoresis (ricrolin+) for 5 min
Every 2 min
Every 2 min
Soeters [18]2015NetherlandsRCTSCXL
TECXL
26
35
25.90
26.90
123/30
3/30
5.4
5.4
0.1
0.1
With 20% dextran every 2 min for 30 min
With ricrolin TE every for 30 min
Every 5 min
Every 5 min
Stojanovic [30]2014NorwayRCTSCXL
TECXl
20
20
29.5
29.5
123/30
3/30
5.4
5.4
0.5
0.5
Vitamin B2 applied alternating every 30 sec
BAC and vitamin B2 applied alternating every 30 sec

Vinciguerra [31]2016ItalyNon-RCTSCXL
TECXl
20
20
28.2
27.8
123/30
10/9
5.4
5.4
0.1
0.1
With 20% dextran every 1 min for 30 min
With iontophoresis (ricrolin+) for 5 min
NR
NR

SCXL = standard cross-linking, TECXL = transepithelial cross-linking, BAC = benzalkonium chloride, HPMC = hydroxypropyl methylcellulose, RCT = randomized controlled trail, NR = not reported, ricrolin TE = 0.1% riboflavin-15% dextran solution supplement with trihydroxypropyl aminomethane and sodium EDTA, and ricrolin+ = dextran-free ethylenediaminetetraacetic acid and trometamol-enriched 0.1% riboflavin-5-phosphate hypotonic solution; vitamin B2 = 0.5% aqueous riboflavin solution without dextran.