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



Niazi S1, 2 ; Doroodgar F1, 2 ; Hashemi Nazari S3 ; Rahimi Y4 ; Alio Del Barrio JL5, 6 ; Gatzioufas Z7 ; Findl O8 ; Vinciguerra P9, 10 ; Vinciguerra R11 ; Moshirfar M12 ; Alio JL5, 6
Authors
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Authors Affiliations
  1. 1. Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Vissum Miranza, Alicante, Spain
  6. 6. Division of Ophthalmology, Universidad Miguel Hernandez, Alicante, Spain
  7. 7. University Eye Hospital Basel, Basel, Switzerland
  8. 8. Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, 1140, Austria
  9. 9. Biomedical Sciences, Humanitas University, Milan, Italy
  10. 10. IRCCS Humanitas Research Hospital, Rozzano, Italy
  11. 11. Humanitas San Pio X Hospital, Milan, Italy
  12. 12. John A. Moran Eye Center, University of Utah, Salt Lake City, UT, United States
  13. 13. Instituto de Olhos Renato Ambrosio, Rio de Janeiro, Brazil
  14. 14. Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
  15. 15. BrAIN: Brazilian Artificial Intelligence Networking in Medicine, Maceio, Rio de Janeiro, Brazil
  16. 16. Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
  17. 17. Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil

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.
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