{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:55:47Z","timestamp":1775022947752,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T00:00:00Z","timestamp":1543449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare the safety and efficacy of standard 30\u00a0min epithelium\u2010off cross\u2010linking (<jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content>) versus photorefractive keratectomy (<jats:styled-content style=\"fixed-case\">PRK<\/jats:styled-content>) combined with accelerated epithelium\u2010off cross\u2010linking (<jats:styled-content style=\"fixed-case\">AXL<\/jats:styled-content>) for the treatment of progressive keratoconus (<jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content>\u2010Plus).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content>. Group B included 67 eyes treated with combined <jats:styled-content style=\"fixed-case\">PRK<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">AXL<\/jats:styled-content>. The recorded data included <jats:styled-content style=\"fixed-case\">UDVA<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> CDVA<\/jats:styled-content>, subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24\u00a0months of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In group A, at 24\u00a0months of <jats:styled-content style=\"fixed-case\">UDVA<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CDVA<\/jats:styled-content> were improved from 1.12\u00a0\u00b1\u00a00.38 and 0.58\u00a0\u00b1\u00a00.42 to 0.66\u00a0\u00b1\u00a00.20 and 0.20\u00a0\u00b1\u00a00.12 (Log<jats:styled-content style=\"fixed-case\">MAR<\/jats:styled-content>\u00b1<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>). The spherical equivalent was reduced from 4.03\u00a0\u00b1\u00a01.18 to 1.78\u00a0\u00b1\u00a01.04 D. The cylinder reduction was 0.32\u00a0\u00b1\u00a00.19 D. In group B, at 24\u00a0months of <jats:styled-content style=\"fixed-case\">UDVA<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CDVA<\/jats:styled-content> were improved from 1.26\u00a0\u00b1\u00a00.52 and 0.68\u00a0\u00b1\u00a00.36 to 0.58\u00a0\u00b1\u00a00.28 and 0.20\u00a0\u00b1\u00a00.16 (Log<jats:styled-content style=\"fixed-case\">MAR<\/jats:styled-content>\u00a0\u00b1\u00a0<jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content>). The spherical equivalent was reduced from 4.23\u00a0\u00b1\u00a00.95 to 1.92\u00a0\u00b1\u00a00.74 D. The cylinder reduction was \u00b11.76 D.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Surprisingly, standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content> showed close results to <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content>\u2010Plus at the 24th follow\u2010up month. Standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content> acted as a stabilizing procedure associated with a late myopic component reduction. <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content>\u2010Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content> seems to be more powerful than <jats:styled-content style=\"fixed-case\">AXL<\/jats:styled-content> in its long\u2010term effect. Therefore, in the future, we want to test the combination of <jats:styled-content style=\"fixed-case\">PRK<\/jats:styled-content> with standard <jats:styled-content style=\"fixed-case\">CXL<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.13986","type":"journal-article","created":{"date-parts":[[2018,11,30]],"date-time":"2018-11-30T06:35:22Z","timestamp":1543559722000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Standard cross\u2010linking versus photorefractive keratectomy combined with accelerated cross\u2010linking for keratoconus management: a comparative study"],"prefix":"10.1111","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7954-1277","authenticated-orcid":false,"given":"Mohammed","family":"Iqbal","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Faculty of Medicine Sohag University Sohag 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