Table 4.
Comparative randomized control trials between accelerated cross-linking protocols vs the Dresden protocol
| Author | Number of eyes and protocol used | Follow-up (months) | Outcomes |
|---|---|---|---|
| Hashemi et al. [92] | 31 eyes 18 mW/cm2 5 min vs 31 eyes Dresden protocol | 18 | Comparable outcomes and safety profile between methods |
| Sherif [93] | 14 eyes 30 mW/cm2 for 4 min 20 s vs 11 eyes Dresden protocol | 12 | Both groups had comparable visual acuity improvement |
| Ng et al. [99] | 12 eyes 9 mW/cm2 for 10 min vs 14 eyes Dresden protocol | 13.9 ± 6.3 | Both procedures stopped keratoconus progression. Conventional group presented greater corneal flattening, which correlated with a deeper corneal stromal demarcation line |
| Razmjoo et al. [100] | 20 eyes 18 mW/cm2 for 5 min vs 20 eyes Dresden protocol | 6 | No significant difference in visual acuity, refractive criteria, and topographic criteria |
| Cınar et al. [101] | 13 eyes 9 mW/cm2 for 10 min vs 13 eyes Dresden protocol | 6 | No statistically significant difference in visual and refractive results between the two groups |
| Choi et al. [102] | 13 eyes 30 mW/cm2 for 3 min 40 s vs 15 eyes Dresden protocol | 6 | A-CXL showed a smaller topographic flattening effect than did the conventional Dresden protocol |
| Tomita et al. [96] | 30 eyes had 15 min riboflavin pre-soak and 30 mW/cm2 3 min vs 18 eyes Dresden protocol | 12 | Both procedures were safe and efficient in halting keratoconus progression |
| Shetty et al. [103] |
36 eyes, 3 mW/cm2 for 30 min 36 eyes, 9 mW/cm2 for 10 min 33 eyes, 18 mW/cm2 for 5 min 33 eyes, 30 mW/cm2 for 3 min |
12 | Conventional CXL and accelerated CXL with irradiations of 9 and 18 mW/cm2 showed better visual, refractive, and tomographic results |
| Sadoughi et al. [104] |
12 eyes 9 mW/cm2 for 10 min 12 eyes Dresden protocol |
12 | Similar refractive, visual, keratometric, and aberrometric results and less adverse effects on the corneal thickness and endothelial cells on both groups |
| Cummings et al. [105] |
66 eyes, Dresden protocol 36 eyes, 9 mW/cm2 for 10 min |
12 | Better flattening effect in accelerated group |
CXL cornea cross-linking, A-CXL accelerated cornea cross-linking