Assessment of postoperative corneal healing after epithelium‐off cross‐linking with a regenerating agent in progressive keratoconus patients

Purpose To evaluate and compare data on corneal healing from randomised clinical trials (RCTs) in adult patients with progressive keratoconus undergoing epithelium‐off corneal collagen cross‐linking (epi‐off CXL) and receiving a regenerating agent (RGTA). Methods An individual study review and a meta‐analysis were performed by searching RCTs assessing the effect of RGTA (Cacicol®) postoperatively used for keratoconus. We focused on the outcome related to corneal healing and epithelial defect size measured by slit lamp/photography with fluorescein staining or optical coherence tomography. Other endpoints related to symptoms included ocular pain, burning, stinging, tearing, photophobia, conjunctival hyperaemia, and postooperative consumption of analgesics. Results Three RCTs were identified for the meta‐analysis including 118 patients (136 eyes) in total. The individual review showed faster reepithelialisation after instillations of RGTA compared to standard postoperative treatment (respectively, 83.3 vs. 13.3% of patients healed at day 2 postoperatively, p