{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T15:32:18Z","timestamp":1785598338944,"version":"3.56.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T00:00:00Z","timestamp":1597276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T00:00:00Z","timestamp":1597276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100010607","name":"Universit\u00e0 degli Studi di Perugia","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010607","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Ophthalmol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Purpose<\/jats:title>\n<jats:p>To evaluate the safety and efficacy of corneal collagen cross-linking (CXL) performed on overlaying a corneal lenticule to thin recipient corneas of progressive keratoconus (KC) patients.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>In this study were enrolled eyes of patients affected by progressive KC with a minimum corneal thickness less than 400\u00a0\u00b5m, after overlaying a lenticule of human corneal stroma prepared with the femtosecond laser. The lenticules used were 100\u00a0\u00b5m thick and of 8.5\u00a0mm diameter in all the cases. Both the host cornea and the lenticules were subjected to epithelial debridement. CXL was carried out according to the standard protocol. Visual acuity, refraction, slit-lamp examination, endothelial cell density, pachymetry and keratometry, anterior segment tomography (AS-OCT) and confocal microscopy were evaluated preoperatively and at 1, 3, 6 and 12\u00a0months postoperatively.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>CXL was performed in 10 eyes of 8 patients (main age 23), corneal thickness range 379\u2013414\u00a0\u00b5m, mean 387.6\u00a0\u00b5m. One patient was lost at follow-up. In all other cases, visual acuity and the endothelial cell density remained stable over a 12-month follow-up. Preoperative mean K1 and mean K2 were 46.91\u2009\u00b1\u20091.9 and 50.75\u2009\u00b1\u20092.93, respectively, and at 12\u00a0months mean K1 was 47.36\u2009\u00b1\u20092.66 and mean K2 50.53\u2009\u00b1\u20093.35. The AS-OCT clearly showed a demarcation line in all patients at 1, 3 (mean depth 283\u00a0\u00b5m and 267\u00a0\u00b5m, respectively) and in some cases at 6\u00a0months. Reduced keratocyte density and stromal oedema were observed immediately up to 1\u00a0month after treatment, while a slight subepithelial haze was present at 1-month and completely disappeared by 6\u00a0months.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This new technique seems to offer a therapeutic opportunity for young patients suffering from progressive KC with very thin corneas, in which the standard treatment is not indicate, and delay or avoid the need for a corneal transplant.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s10792-020-01526-x","type":"journal-article","created":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T18:04:01Z","timestamp":1597341841000},"page":"3403-3412","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Epi-off-lenticule-on corneal collagen cross-linking in thin keratoconic corneas"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3812-9219","authenticated-orcid":false,"given":"Carlo","family":"Cagini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Riccitelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Messina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Piccinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Torroni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Said","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Al Maazmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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