{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:21:47Z","timestamp":1791436907041,"version":"4.3.3"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2018,7,29]],"date-time":"2018-07-29T00:00:00Z","timestamp":1532822400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Ophthalmology"],"published-print":{"date-parts":[[2018,7,29]]},"abstract":"<jats:p><jats:italic>Aim<\/jats:italic>. To evaluate two different techniques of cross-linking: standard epithelium-off (CXL epi-off) versus transepithelial (CXL epi-on) cross-linking in patient with progressive keratoconus.<jats:italic>Methods<\/jats:italic>. Forty eyes from 32 patients with progressive keratoconus were prospectively enrolled from June 2014 to June 2015 in this nonblinded, randomized comparative study. Twenty eyes were treated by CXL epi-off and 20 by CLX epi-on, randomly assigned, and followed for 2 years. All patients underwent a complete ophthalmologic testing that included uncorrected and best corrected visual acuity, central and peripheral corneal thickness, corneal astigmatism, simulated maximum, minimum, and average keratometry, corneal confocal microscopy, Schirmer I and break-up time (BUT) tests, and the Ocular Surface Disease Index. Intra- and postoperative complications were recorded. The solution used for CXL epi-off comprised riboflavin 0.1% and dextran 20.0% (Ricrolin), whereas the solution for CXL epi-on (Ricrolin TE) comprised riboflavin 0.1%, dextran 15.0%, trometamol (Tris), and ethylenediaminetetraacetic acid. Ultraviolet-A treatment was performed with a UV-X system at 3\u2009mW\/cm<jats:sup>2<\/jats:sup>.<jats:italic>Results<\/jats:italic>. In both groups, a significant improvement in visual function (Group 1: baseline 0.36\u2009\u00b1\u20090.16 logMAR, two-year follow-up 0.22\u2009\u00b1\u20090.17 logMAR,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.01<\/mml:mn><\/mml:mrow><\/mml:math>; Group 2: baseline 0.32\u2009\u00b1\u20090.18 logMAR, 2-year follow-up 0.27\u2009\u00b1\u20090.19 logMAR,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.01<\/mml:mn><\/mml:mrow><\/mml:math>) was recorded. Keratometry remained unchanged in both groups. The mean corneal thickness showed a significant reduction (mean difference of corneal thickness: \u221255 micron and \u221271 micron, resp.). One-month after treatment, OSDI<jats:sup>\u00a9<\/jats:sup>reached 13.56\u2009\u00b1\u20092.15 in Group 1 (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.03<\/mml:mn><\/mml:mrow><\/mml:math>) and 11.26\u2009\u00b1\u20092.12 in Group 2 (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.04<\/mml:mn><\/mml:mrow><\/mml:math>). At confocal microscopy, abnormal corneal nerve alterations were found in both groups. Fibrotic reaction (43.75%) and activated keratocyte (62.6%) were more commonly recorded in Group 1 than in Group 2 (25.0% and 18.75%), with<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.668<\/mml:mn><\/mml:mrow><\/mml:math>and 0.356, respectively.<jats:italic>Conclusion<\/jats:italic>. Our findings demonstrate that both procedures are able to slow keratoconus progression. Both treatment modalities are equivalent in terms of results and related complications. CXL epi-on technique is preferable to CXL epi-off since it preserves the corneal thickness and improves visual acuity, also reducing the postoperative ocular discomfort during the study period.<\/jats:p>","DOI":"10.1155\/2018\/4947983","type":"journal-article","created":{"date-parts":[[2018,7,29]],"date-time":"2018-07-29T19:31:04Z","timestamp":1532892664000},"page":"1-6","source":"Crossref","is-referenced-by-count":45,"title":["Epi-Off versus Epi-On Corneal Collagen Cross-Linking in Keratoconus Patients: A Comparative Study through 2-Year Follow-Up"],"prefix":"10.1155","volume":"2018","author":[{"given":"F.","family":"Cifariello","sequence":"first","affiliation":[{"name":"Department of Medicine and Health Science, University of Molise, Campobasso, Italy"},{"name":"Casa di Cura \u201cVilla Maria\u201d, Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Minicucci","sequence":"additional","affiliation":[{"name":"I.R.C.S.S. Neuromed, Pozzilli, Isernia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1560-6393","authenticated-orcid":true,"given":"F.","family":"Di Renzo","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science, University of Molise, Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Di Taranto","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science, University of Molise, Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Coclite","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science, University of Molise, Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Zaccaria","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science, University of Molise, Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"De Turris","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science, University of Molise, Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8477-6188","authenticated-orcid":true,"given":"C.","family":"Costagliola","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science, University of Molise, Campobasso, Italy"},{"name":"Casa di Cura \u201cVilla Maria\u201d, Campobasso, Italy"},{"name":"I.R.C.S.S. Neuromed, Pozzilli, Isernia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/406850"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1016\/s0014-4835(80)80027-3"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.2010.01890.x"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1186\/s40662-015-0030-6"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1006\/exer.1997.0410"},{"issue":"7","key":"6","doi-asserted-by":"crossref","first-page":"S720","DOI":"10.3928\/1081597X-20080901-15","volume":"24","year":"2008","journal-title":"Journal of Refractive Surgery"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1097\/ico.0000000000000699"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2009.07.044"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.4103\/0974-620x.149855"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.3928\/1081597x-20100212-09"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2009.01.009"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2008.11.036"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2007.12.039"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1097\/opx.0b013e318269c8e5"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.4103\/0301-4738.116072"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2011.01.010"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1111\/aos.13032"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjo.2013.09.002"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.3928\/1081597x-20160629-02"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1097\/01.icu.0000233959.73262.99"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1111\/cxo.12470"},{"key":"22","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2017.3"},{"key":"23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2015.04.007"},{"key":"24","doi-asserted-by":"publisher","DOI":"10.2147\/opth.s73991"},{"key":"25","doi-asserted-by":"publisher","DOI":"10.1097\/ico.0000000000000547"},{"key":"26","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/498435"},{"key":"27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2015.02.005"},{"key":"28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2010.10.052"},{"key":"29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.01.040"},{"key":"30","doi-asserted-by":"publisher","DOI":"10.1007\/s40123-017-0076-8"},{"key":"31","doi-asserted-by":"publisher","DOI":"10.18240\/ijo.2017.09.15"},{"key":"32","doi-asserted-by":"publisher","DOI":"10.1097\/ico.0b013e318030df5a"},{"key":"33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2008.09.035"},{"key":"34","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.2010.02035.x"}],"container-title":["Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/joph\/2018\/4947983.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/joph\/2018\/4947983.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/joph\/2018\/4947983.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T08:35:03Z","timestamp":1571646903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/joph\/2018\/4947983\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,29]]},"references-count":34,"alternative-id":["4947983","4947983"],"URL":"https:\/\/doi.org\/10.1155\/2018\/4947983","relation":{},"ISSN":["2090-004X","2090-0058"],"issn-type":[{"value":"2090-004X","type":"print"},{"value":"2090-0058","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,29]]}}}