Small-Incision Lenticule Extraction with Prophylactic Cross-Linking: A Systematic Review and Meta-Analysis

Evidence database / Studies / sadek-2026-klex-cxl-meta-analysis

—enrolled patients*

730enrolled eyes*

1structured arms

30maximum standardized days follow-up

* Descriptive sum of reported arm counts. “≥” indicates that one or more arm counts were not reported; missing values are not treated as zero.

Study arm

KLEx versus KLEx with prophylactic cross-linking

SMILE

Population

Patients: Not reported
Eyes: 730
Bilateral treatment: Not reported
Age range: Not reported
Sphere range: Not reported
Cylinder range: Not reported
Spherical equivalent: Not reported
Corneal thickness: Not reported

Eligibility definition

Inclusion
Comparative adult studies reporting refractive or visual outcomes after KLEx and KLEx-CXL with at least six months of follow-up.

Exclusion
Not structured

Reported outcomes by follow-up

Outcome	Follow-up	Follow-up sample	Result	Reported fraction	Provenance
Residual MRSE mean difference refractive	Pooled follow-up	730 eyes	0.03 D	denominator: 9 studies	VERIFIED Source · Abstract
Uncorrected distance vision mean difference efficacy	1 month	—	-0.040 logMAR	Not reported	VERIFIED Source · Abstract
Safety index mean difference safety	1 month	—	0.07	Not reported	VERIFIED Source · Abstract
Efficacy index mean difference efficacy	1 month	—	0.08	Not reported	VERIFIED Source · Abstract

Complications

No structured complication observations are available for this arm. This means “not reported in this dataset,” not zero complications.

Study design

Systematic review and random-effects meta-analysis of nine comparative adult studies with at least six months of follow-up.

Country: Not reported
Publication-reported places: Not reported
Multicenter: Yes
Prospective: Not reported
Randomized: Not reported
Source type: META ANALYSIS
Regulator: Not reported

Place metadata may refer to a treatment site, institution or author affiliation. Confirm its role in the linked publication.

Limitations and notes

KLEx is represented under SMILE. Comparative effect estimates are differences between KLEx alone and KLEx with prophylactic cross-linking, not absolute event rates.

Missing fields are not interpreted as negative findings. Arm counts may not be additive in all study designs.

Study evidence level
A simple, non-GRADE hierarchy based on design: randomized and large regulatory trials are high; prospective cohorts moderate; retrospective observational studies low. Manual review can override this label.