Refractive Surgical Approaches to Keratoconus: A Systematic Review and Network Meta-Analysis Publisher Pubmed



Niazi S^{1, 2} ; Doroodgar F^{1, 2} ; Hashemi Nazari S³ ; Rahimi Y⁴ ; Alio Del Barrio JL^{5, 6} ; Gatzioufas Z⁷ ; Findl O⁸ ; Vinciguerra P^{9, 10} ; Vinciguerra R¹¹ ; Moshirfar M¹² ; Alio JL^{5, 6} Show Affiliations
Source: Survey of Ophthalmology Published:2024

Abstract

Advancements in diagnostic methods and surgical techniques for keratoconus (KC) have increased non-invasive treatment options. Successful surgical planning for KC involves a combination of clinical science, empirical evidence, and surgical expertise. Assessment of disease progression is crucial, and halting the progression should be the focus if it is progressive. While surgeons used to rely on experience alone to decide the surgical method, comparing the network of primary factors, such as visual acuity, across studies can help them choose the most appropriate treatments for each patient and achieve optimal outcomes. Meticulous tabulation methods facilitate interpretation, highlighting the importance of selecting the correct surgical and rehabilitation approach based on each patient's condition and stage of the disease. We detail the outcomes of a comprehensive network meta-analysis comparing the effectiveness of various combined therapeutic refractive treatments for KC at identical stages of the disease, spanning 4 distinct follow-up intervals. Additionally, the comprehensive analysis suggests that for corneas with optimal best corrected visual acuity (BCVA) preoperatively (classified as regular), combining phakic intraocular lenses with intracorneal ring segments (ICRS) and corneal cross-linking (CXL) could offer the best therapeutic approach provided the disease stage does not exceed stage 3. For irregular corneas, although initial follow-ups show a significant difference in BCVA with surface ablation, longer-term follow-ups recommend combining surface ablation with ICRS and CXL, especially at higher stages. © 2024 Elsevier Inc.