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Visual acuity (corrected and uncorrected), tomographic parameters and endothelial cell count were obtained at baseline and after 1\u2009year. Corneae thinner than 400\u2009\u03bcm were also included. A safety limit of 400\u2009\u03bcm was used, and sterile water was added if the corneae fell short of this limit during the treatment. Primary outcome: Change in\n                      <jats:italic>K<\/jats:italic>\n                      max.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were no statistically significant differences in any of the parameters between the isoosmolar and hypoosmolar groups. In the isoosmolar group, 74% of the patients required the addition of sterile water, while only 15% required it in the hypoosmolar group. The measurements of densitometry in the 0\u20132\u2009mm zone improved less in the group that received sterile water; otherwise, there were no statistically significant differences in any of the parameters between the groups that did and did not receive the addition of sterile water.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this study demonstrate the efficacy and safety in using hypoosmolar riboflavin when performing CXL for progressive keratoconus. The results also demonstrate the efficacy and safety of using sterile water in corneae thinner than 400\u2009\u03bcm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.17551","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T11:59:47Z","timestamp":1752062387000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A randomised controlled trial on cross\u2010linking protocols for the treatment of progressive keratoconus using isoosmolar and hypoosmolar riboflavin with the addition of sterile water in thin corneae"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7001-0202","authenticated-orcid":false,"given":"Ingemar","family":"Gustafsson","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Sk\u00e5ne University Hospital  Lund Sweden"},{"name":"Department of Clinical Sciences Lund University  Lund 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