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The investigation focused on tomographic and keratometric parameters, refractive data, and visual outcomes at 5\u00a0years follow-ups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Corrected distance visual acuity (CDVA), slit lamp, and Pentacam\u00ae examinations were conducted, including assessments of thinnest corneal point (TP), minimum radius (Rmin), corneal astigmatism, and maximum anterior keratometry (Kmax). These examinations were performed two weeks before the surgery and, on average, 56\u00a0months after the surgery. In a subgroup of 24 eyes, Pentacam\u00ae examination data from an intermediate visit at 12\u00a0months until the final visit was evaluated to confirm continuous stability.<\/jats:p>\n                <jats:p>The ACXL protocol included corneal abrasion, hydroxypropylmethylcellulose (HPMC)-riboflavin eye drops administered every 5\u00a0min for a total duration of 30\u00a0min, and irradiation with 18mW\/cm2 for 5\u00a0min using riboflavin eye drops applied every minute during the irradiation process. Intraoperatively, minimal corneal pachymetry of\u2009&gt;\u2009400\u00a0\u00b5m was ensured in every patient.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>After 56\u00a0months, all values exhibited statistically significant changes (paired t-test; CDVA <jats:italic>p<\/jats:italic>\u2009=\u20090.002; Kmax <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; Rmin <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; astigmatism <jats:italic>p<\/jats:italic>\u2009=\u20090.03; TP <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n                <jats:p>In the subgroup analysis of 24 eyes, which included tomographical and keratometric parameters, no statistically significant changes were observed during the last 12\u00a0months of observation (paired t-test; Kmax <jats:italic>p<\/jats:italic>\u2009=\u20090.72; Rmin <jats:italic>p<\/jats:italic>\u2009=\u20090.67; astigmatism <jats:italic>p<\/jats:italic>\u2009=\u20090.72).<\/jats:p>\n                <jats:p>Treatment failure was strictly defined as an increase in Kmax (&gt;\u20091D) during the 5-year follow-up and was observed in only 3 eyes (4%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>ACXL is an effective and safe treatment for patients with progressive keratoconus. Our results demonstrate improvements in functional and tomographical outcomes even after high-energy ACXL (18mW\/cm2 for 5\u00a0min) over a long-term period of 56\u00a0months. Our analysis indicates stable conditions in previously progressive keratoconus, particularly during the final year of the observation period. The treatment failure rate was 4%.\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00417-023-06225-8","type":"journal-article","created":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T11:01:48Z","timestamp":1693998108000},"page":"871-877","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Accelerated corneal cross-linking (18mW\/cm2 for 5\u00a0min) with HPMC-riboflavin in progressive keratoconus \u2013 5\u00a0years follow-up"],"prefix":"10.1007","volume":"262","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7062-7306","authenticated-orcid":false,"given":"Julia","family":"Friedrich","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Sandner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Nasseri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathias","family":"Maier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Zapp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,9,6]]},"reference":[{"issue":"4","key":"6225_CR1","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/0039-6257(84)90094-8","volume":"28","author":"JH Krachmer","year":"1984","unstructured":"Krachmer JH, Feder RS, Belin MW (1984) Keratoconus and related noninflammatory corneal thinning disorders. 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