We will assess the quality of individual RCTs using the Cochrane risk of bias assessment tool. Two reviewers will independently screen search results to identify eligible studies, complete data abstraction and conduct quality assessment. We will search 16 electronic databases including MEDLINE and Embase, as well as the grey literature. This study will systematically review the evidence on transepithelial CXL approaches and compare it to the epithelium-off protocol.Methods and analysisWe will include randomised controlled trials (RCTs) comparing transepithelial and epithelium-off CXL for any corneal ectasia. Whether novel transepithelial approaches are as effective in arresting ectasia as the established epithelium-off protocol remains unclear.
However, some surgeons have proposed transepithelial approaches to enhance patient recovery and minimise adverse events. The established CXL protocol requires removal of the corneal epithelium. Corneal collagen cross-linking (CXL) increases the biomechanical rigidity of the cornea and has been shown to halt ectatic processes. IntroductionCorneal ectasias are progressive, degenerative ocular diseases defined by abnormal structural changes in the cornea, leading to distortion of vision and substantial reduction in quality of life.
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