{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:00:19Z","timestamp":1783720819983,"version":"3.55.0"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Standard epithelium\u2010off collagen cross\u2010linking using Dresden protocol (S\u2010CXL) is the standard of care for progressive keratoconus. Despite its efficacy, epithelial debridement is associated with pain, delayed visual rehabilitation, stromal oedema and haze. Minimising these complications while achieving a comparable efficacy remains an unmet need.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Comparative studies between transepithelial iontophoresis\u2010assisted CXL (I\u2010CXL) and S\u2010CXL reporting the outcomes of visual, refractive, topographic, aberrometry, demarcation line, endothelial cell density, confocal microscopy or complications were identified from databases. Assessments of publication bias, meta\u2010analyses, sensitivity analysis, subgroup analysis, and meta\u2010regressions were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In this meta\u2010analysis, 586 eyes from three randomised controlled trials and seven comparative studies were analysed. No differences were found in the change in uncorrected\/corrected distance visual acuities, mean\/maximum keratometry, central corneal thickness, higher order aberration, spherical aberration, coma, subbasal nerve\/anterior stromal keratocyte density and demarcation line depth in both CXL protocols (<jats:italic>P<\/jats:italic>\u2009\u2265\u2009.052). However, I\u2010CXL resulted in less thinning at the minimum pachymetry (standardised mean difference 0.25; 95% confidence interval [CI] 0.06\u20100.44). More importantly, there was a significant reduction in complications following I\u2010CXL (odds ratio 0.30; 95% CI 0.12\u20100.75). Meta\u2010regression analyses on demarcation line depth and complication suggested that I\u2010CXL was more effective than S\u2010CXL when baseline maximum keratometry was &gt;55.2 D and the risk of complication was independent of other baseline covariates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>I\u2010CXL has a more favourable safety profile, as evidenced by the available literature, with less thinning at the minimum pachymetry and reduced risk of complications while achieving comparable effects on visual, refractive, topographic, aberrometry, and morphological outcomes as S\u2010CXL.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ceo.13918","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T14:22:30Z","timestamp":1614954150000},"page":"228-241","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Transepithelial corneal collagen cross\u2010linking using iontophoresis versus the Dresden protocol in progressive keratoconus: A meta\u2010analysis"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0307-2256","authenticated-orcid":false,"given":"Kelvin H.","family":"Wan","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences The Chinese University of Hong Kong  Kowloon Hong Kong"},{"name":"Hong Kong Eye Hospital  Kowloon Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina K. 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