Comparison of refractive surgeries (SMILE, LASIK, and PRK) with and without corneal cross-linking: a systematic review and meta-analysis

Abstract

Abstract Corneal collagen cross-linking (CXL) is used for treating Keratoconus and Post LASIK ectasia. However, refractive surgery is not usually performed with prophylactic CXL. Therefore, we performed a meta-analysis comparing outcomes of refractive surgeries with versus without prophylactic CXL. We systematically searched databases for studies comparing refractive surgeries for myopic correction with versus without prophylactic corneal crosslinking. Review Manager 5.4.1 was used to perform the statistical analysis. We included 2820 eyes from 28 studies. Compared to refractive surgery alone, surgery with prophylactic corneal cross-linking resulted in decreased central corneal thickness, corrected distance visual acuity (CDVA) logMAR, safety and efficacy indices. There were no significant differences in postoperative uncorrected distance visual acuity (UDVA) of 20/20 or better at ≥ 12 months and other visual outcomes among both groups. More RCTs with standard cross-linking protocols are needed to analyze the prophylactic use of cross-linking with refractive surgeries.