{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:15:01Z","timestamp":1790349301085,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T00:00:00Z","timestamp":1666569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001108","name":"Ophthalmic Research Institute of Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We aimed to determine the long\u2010term outcomes of epithelium\u2010off cross\u2010linking (CXL) in keratoconus patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An observational registry study from 41 centres across 5 countries was carried out. Primary outcomes included the mean change in visual acuity (VA), Kmax, K2, and thinnest corneal thickness (TCT) at 1\u20135\u2009years. Secondary outcomes included the percentage of eyes with worsening, stable and improving outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 976 eyes of 794 patients with 1\u2010year of complete follow\u2010up, 501 eyes with 2\u2010years, 355 with 3\u2010years, 235 with 4\u2010years and 162 with 5\u2010years. There was a significant improvement in mean VA from baseline by 3.7 logMAR letters (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001) in year 1, and 6.9 (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001) in year 5. Mean Kmax decreased by 1.2 dioptres (D;<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.01) in year 1. During subsequent years the Kmax flattening appeared sustained but this was not statistically significant. K2 flattened significantly from baseline in year 1 and then remained stable. At 1\u00a0year, 4.1% patients were poor responders to CXL in terms of VA, losing \u226515 letters. The proportion of the poor responders remained unchanged: 4.9% at 5\u2010years. The proportion of poor responders in terms of Kmax remained similar: 5.9% steepening by \u22652D at 1\u2010year and 7.5% at 5\u2010years. The proportion of K2 poor responders remained stable with 4.7% steepening by \u22652D at 1\u2010year and 5.8% at 5\u2010years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cross\u2010linking is effective at stabilising keratoconus up to 5\u2009years in most patients. However, a small proportion of eyes failed to stabilise and had reduced vision.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ceo.14177","type":"journal-article","created":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T16:25:05Z","timestamp":1665764705000},"page":"9-18","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Five\u2010year corneal cross\u2010linking outcomes: A Save Sight Keratoconus Registry Study"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2895-3087","authenticated-orcid":false,"given":"Alex C.","family":"Ferdi","sequence":"first","affiliation":[{"name":"Specialty of Clinical Ophthalmology and Eye Health, Sydney Medical School Save Sight Institute, The University of Sydney Sydney New South Wales 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