{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:00:43Z","timestamp":1783720843024,"version":"3.55.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T00:00:00Z","timestamp":1571961600000},"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":[[2020,5]]},"abstract":"Abstract<\/jats:title>Purpose<\/jats:title>To compare the efficacy, safety and stability of standard epithelium\u2010off cross\u2010linking (SCXL<\/jats:styled-content>) versus accelerated epithelium\u2010off cross\u2010linking (ACXL<\/jats:styled-content>) and transepithelial epithelium\u2010on cross\u2010linking (TCXL<\/jats:styled-content>) in the treatment of progressive keratoconus (KC<\/jats:styled-content>) in children.<\/jats:p><\/jats:sec>Methods<\/jats:title>This prospective multicentre controlled trial included 271 eyes (136 children) with grade 1\u20133 progressive KC<\/jats:styled-content> who were randomized to undergo SCXL<\/jats:styled-content> (n\u00a0=\u00a091, as a control group), ACXL<\/jats:styled-content> (n\u00a0=\u00a092) or TCXL<\/jats:styled-content> (n\u00a0=\u00a088). Uncorrected and corrected distance visual acuity, subjective refraction, pachymetry, keratometry and corneal topography measurements were recorded preoperatively and 6, 12 and 24\u00a0months postoperatively.<\/jats:p><\/jats:sec>Results<\/jats:title>At 1\u00a0year, there was no significant difference in uncorrected distance visual acuity, refractive sphere, cylinder, spherical equivalent or Kmax between the ACXL<\/jats:styled-content> and SCXL<\/jats:styled-content> groups; however, during year 2, ACXL<\/jats:styled-content> regressed while SCXL<\/jats:styled-content> continued to improve. After 2\u00a0years, there were significant differences in all visual, refractive and keratometric components between SCXL<\/jats:styled-content> and both ACXL<\/jats:styled-content> and TCXL<\/jats:styled-content> (p\u00a0<\u00a00.0001) and between ACXL<\/jats:styled-content> and TCXL<\/jats:styled-content> (p\u00a0<\u00a00.0001). KC<\/jats:styled-content> progressed in 5.4% of patients who had ACXL<\/jats:styled-content> and 28.4% of those who had TCXL<\/jats:styled-content> but in none of those who had SCXL<\/jats:styled-content>. Vernal keratoconjunctivitis was documented in 43.3% of eyes that progressed postoperatively.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>SCXL<\/jats:styled-content> was more effective for paediatric KC<\/jats:styled-content> and achieved greater stability than either ACXL<\/jats:styled-content> or TCXL<\/jats:styled-content>, and ACXL<\/jats:styled-content> was superior to TCXL<\/jats:styled-content>. SCXL<\/jats:styled-content> also achieved marked improvement in both myopia and spherical equivalent; however, these refractive outcomes were unpredictable and uncontrollable. TCXL<\/jats:styled-content> had a 28.4% failure rate within 2\u00a0years. SCXL<\/jats:styled-content> is preferable for management of paediatric KC<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.14275","type":"journal-article","created":{"date-parts":[[2019,10,26]],"date-time":"2019-10-26T05:54:19Z","timestamp":1572069259000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Standard cross\u2010linking protocol versus accelerated and transepithelial cross\u2010linking protocols for treatment of paediatric keratoconus: a 2\u2010year comparative study"],"prefix":"10.1111","volume":"98","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 Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4221-8932","authenticated-orcid":false,"given":"Ahmed","family":"Elmassry","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Faculty of Medicine Alexandria University Alexandria Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisham","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Faculty of Medicine Tanta University Tanta Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"AM Gad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Faculty of Medicine Zagazig University Zagazig Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Faculty of Medicine Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noha","family":"Hamed","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Faculty of Medicine Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Faculty of Medicine Benha University Benha Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"S. 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