{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:12:11Z","timestamp":1789499531907,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,12]],"date-time":"2018-11-12T00:00:00Z","timestamp":1541980800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Contact lens\u2010assisted corneal cross\u2010linking (<jats:styled-content style=\"fixed-case\">CACXL<\/jats:styled-content>) has been proposed for the cross\u2010linking treatment in thin corneas. The aim of this study was to assess the biomechanical efficacy of this treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Post\u2010mortem porcine eyes were treated with standard cross\u2010linking and with cross\u2010linking placing a contact lens soaked with isoosmolar riboflavin solution on the debrided cornea with or without an adherent precorneal riboflavin film of up to 100\u00a0<jats:italic>\u03bc<\/jats:italic>m thickness. Three soft contact lenses (Air Optix Aqua, SofLens and Galifa) with different degrees of hydrophilic properties were tested. After cross\u2010linking with a surface <jats:styled-content style=\"fixed-case\">UVA<\/jats:styled-content> irradiance of 3\u00a0<jats:styled-content style=\"fixed-case\">mW<\/jats:styled-content>\/cm\u00b2 for 30\u00a0min (fluence 5.4\u00a0J\/cm\u00b2), a 400\u00a0<jats:italic>\u03bc<\/jats:italic>m deep anterior corneal flap was created using a lamellar rotating microkeratome. Biomechanical stress\u2013strain measurements and thermal shrinkage tests were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the Air Optix Aqua group (30% hydration) without riboflavin film, Young\u2032s modulus and stress at 8% strain were increased significantly versus untreated controls and the effect was 92.4% respectively 86.35% of the standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content> value. In the SofLens group (59% hydration) without riboflavin film, Young\u2032s modulus and stress at 8% strain were increased significantly versus untreated controls and the effect was 67.04% respectively 65.28% of the standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content> value. In the Galifa group (72% hydration) without riboflavin film, Young\u2032s modulus and stress at 8% strain were increased significantly versus untreated controls and the effect was about 68.48% respectively 75.52% of the\u00a0standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content> value. In all samples with a precorneal riboflavin film under the contact lens, there was no significant biomechanical effect compared to the untreated controls. Similarly, in the hydrothermal experiments at 70\u00b0C, there was a typical mushroom pattern with increased resistance to thermal shrinkage in the anterior stroma after standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content>, a markedly reduced mushroom effect using a riboflavin\u2010soaked contact lens only and no effect with the use of a riboflavin\u2010soaked contact lens plus a precorneal riboflavin film.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The biomechanical effect of <jats:styled-content style=\"fixed-case\">CACXL<\/jats:styled-content> in porcine corneas is about one\u2010third less than after standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content>. The efficacy of <jats:styled-content style=\"fixed-case\">CACXL<\/jats:styled-content> might be improved by reducing or omitting the riboflavin film on the contact lens. Further risk assessment studies are necessary.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.13828","type":"journal-article","created":{"date-parts":[[2018,11,13]],"date-time":"2018-11-13T07:38:42Z","timestamp":1542094722000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Biomechanical efficacy of contact lens\u2010assisted collagen cross\u2010linking in porcine eyes"],"prefix":"10.1111","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4248-2020","authenticated-orcid":false,"given":"Gregor","family":"Wollensak","sequence":"first","affiliation":[{"name":"AugenMVZ Hoyerswerda Hoyerswerda Germany"},{"name":"Department of Ophthalmology Carl Thiem Klinikum Cottbus Cottbus Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eberhard","family":"Sp\u00f6rl","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Technical University of Dresden Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Herbst","sequence":"additional","affiliation":[{"name":"Department of Pathology Vivantes Klinikum Neuk\u00f6lln Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20171025-01"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2009.10.021"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e31822159f6"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2009.06.031"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00347-009-2127-6"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2010.06.067"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2008.10.060"},{"key":"e_1_2_6_9_1","first-page":"40","article-title":"A better choice. 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