{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T07:43:37Z","timestamp":1782459817839,"version":"3.54.5"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"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":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study is to assess the effect of various fluence levels on prophylactic corneal cross\u2010linking (CXL) combined with femtosecond laser in situ keratomileusis (FS\u2010LASIK\u2010Xtra) or transepithelial photorefractive keratectomy (TransPRK\u2010Xtra) on biomechanics, demarcation line (DL), and stromal haze.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Prospective analysis where two prophylactic CXL protocols (lower\/higher fluence [LF\/HF]: 30\u2009mw\/cm<jats:sup>2<\/jats:sup>, 60\/80\u2009s, 1.8\/2.4\u00a0J\/cm<jats:sup>2<\/jats:sup>) were performed as part of either an FS\u2010LASIK\u2010Xtra or TransPRK\u2010Xtra procedure. Data were collected preoperatively and at 1\u00a0week and 1, 3, and 6\u00a0months postoperatively. Main outcome measures were (1) dynamic corneal response parameters and the stress\u2013strain index (SSI) from Corvis, (2) actual DL depth (ADL), and (3) stromal haze on OCT images analysed by a machine learning algorithm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eighty\u2010six eyes from 86 patients underwent FS\u2010LASIK\u2010Xtra\u2010HF (21 eyes), FS\u2010LASIK\u2010Xtra\u2010LF (21 eyes), TransPRK\u2010Xtra\u2010HF (23 eyes), and TransPRK\u2010Xtra\u2010LF (21 eyes). SSI increased similarly by around 15% in all groups 6\u00a0months postoperatively (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.155). All other corneal biomechanical parameters were statistically significant worsening postoperatively, but the change was similar in all groups. At 1\u00a0month postoperatively, there was no statistical difference in mean ADL among four groups (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.613), mean stromal haze was similar between the two FS\u2010LASIK\u2010Xtra groups, but higher in the TransPRK\u2010Xtra\u2010HF group compared with the TransPRK\u2010Xtra\u2010LF group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>FS\u2010LASIK\u2010Xtra and TransPRK\u2010Xtra lead to a similar ADL and improve SSI equally. Lower fluence prophylactic CXL might be recommended as it achieves similar mean ADL with potentially less induced stromal haze, especially in TransPRK. The clinical relevance and applicability of such protocols remains to be assessed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.15230","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T08:49:26Z","timestamp":1659689366000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Effect of fluence levels on prophylactic corneal cross\u2010linking for laser in situ keratomileusis and transepithelial photorefractive keratectomy"],"prefix":"10.1111","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3096-9579","authenticated-orcid":false,"given":"Nan\u2010Ji","family":"Lu","sequence":"first","affiliation":[{"name":"Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University National Clinical Research Center for Ocular Diseases  Wenzhou Zhejiang China"},{"name":"Faculty of Medicine and Health Sciences University of Antwerp  Wilrijk 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University of Zurich  Zurich Switzerland"},{"name":"Faculty of Medicine University of Geneva  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jad F.","family":"Assaf","sequence":"additional","affiliation":[{"name":"The American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis M.","family":"Aslanides","sequence":"additional","affiliation":[{"name":"Eye Hospital and School of Ophthalmology and Optometry Wenzhou Medical University National Clinical Research Center for Ocular Diseases  Wenzhou Zhejiang China"},{"name":"Emmetropia Mediterranean Eye Institute  Heraklion Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shady T.","family":"Awwad","sequence":"additional","affiliation":[{"name":"The American University of Beirut Medical Center  Beirut 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