Protocol for a systematic review, meta-analysis, and trial sequential analysis of clinical outcomes following accelerated versus conventional corneal collagen cross-linking for corneal ectasia.


Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. [Email]


Collagen cross-linking (CXL) is an evolving procedure that enhances the biomechanical rigidity of the cornea and can slow or halt ectatic disease. CXL requires delivery of 5.4 J/cm2 of ultraviolet A (UVA) radiation to a cornea saturated with riboflavin in order to induce cross-link formation. The conventional CXL procedure achieves this fluence by exposing the cornea to a 3 mW/cm2 UVA lamp for 30 min; however, some surgeons have proposed accelerated protocols which achieve the same fluence in a shorter period of time by using a higher power light source. Whether accelerated protocols are as effective in arresting ectasia as the established conventional procedure remains unclear. Accordingly, this study will systematically review and synthesise the evidence on accelerated CXL and compare it to the conventional approach across an array of clinical outcomes.


Accelerated,Corneal ectasia,Cross-linking,Keratoconus,Systematic review,

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