{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T11:59:19Z","timestamp":1764935959467,"version":"3.40.5"},"reference-count":61,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T00:00:00Z","timestamp":1595462400000},"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":[[2020,7,23]]},"abstract":"Purpose<\/jats:italic>. The aim of our study was to compare the long-term efficacy and safety of \u201cepi-off\u201d conventional and \u201cepi-off\u201d accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. Methods<\/jats:italic>. \u201cEpithelial-off\u201d (\u201cEpi-off\u201d) CXL using the conventional technique (3\u2009mW\/cm2<\/jats:sup>, 30 minutes) was performed in 93 eyes of 93 patients (S-CXL group) and \u201cepi-off\u201d accelerated method (9\u2009mW\/cm2<\/jats:sup>, 10 minutes) in 76 eyes of 76 patients with progressive KCN (A-CXL group). Cases with different stages of keratoconus and topographic evidence of progression were included. Main outcomes comprised refraction, keratometry measurements, uncorrected (UCVA) and best-corrected visual acuity (BCVA), and topographical indices. Micromorphological analysis was assessed by anterior segment ocular coherence tomography (AS-OCT). The follow-up period was 5 years. Results<\/jats:italic>. In both groups, Kflat presented similar results: decrease at 1 year (p<\/mml:mi>=<\/mml:mo>0.465<\/mml:mn><\/mml:math>), at 2 years (p<\/mml:mi>=<\/mml:mo>0.672<\/mml:mn><\/mml:math>), at 3 years (p<\/mml:mi>=<\/mml:mo>0.198<\/mml:mn><\/mml:math>), at 4 years (p<\/mml:mi>=<\/mml:mo>0.32<\/mml:mn><\/mml:math>), and at 5 years (p<\/mml:mi>=<\/mml:mo>0.864<\/mml:mn><\/mml:math>). In both groups, Ksteep presented a similar decrease at 1 year (p<\/mml:mi>=<\/mml:mo>0.709<\/mml:mn><\/mml:math>), at 2 years (p<\/mml:mi>=<\/mml:mo>0.455<\/mml:mn><\/mml:math>), at 3 years (p<\/mml:mi>=<\/mml:mo>0.43<\/mml:mn><\/mml:math>), at 4 years (p<\/mml:mi>=<\/mml:mo>0.57<\/mml:mn><\/mml:math>), and at 5 years (p<\/mml:mi>=<\/mml:mo>0.494<\/mml:mn><\/mml:math>), with no statistically significant difference. Decrease in Kavg was similar in both groups at all analyzed time points (p<\/mml:mi>=<\/mml:mo>0.18<\/mml:mn><\/mml:math> at 1 year, p<\/mml:mi>=<\/mml:mo>0.093<\/mml:mn><\/mml:math> at 2 years, p<\/mml:mi>=<\/mml:mo>0.57<\/mml:mn><\/mml:math> at 3 years, p<\/mml:mi>=<\/mml:mo>0.154<\/mml:mn><\/mml:math> at 4 years, and p<\/mml:mi>=<\/mml:mo>0.247<\/mml:mn><\/mml:math> at 5 years). Kmax had a similar decrease in both groups at 1 year (p<\/mml:mi>=<\/mml:mo>0.06<\/mml:mn><\/mml:math>), at 2 years (p<\/mml:mi>=<\/mml:mo>0.09<\/mml:mn><\/mml:math>), at 3 years (p<\/mml:mi>=<\/mml:mo>0.126<\/mml:mn><\/mml:math>), at 4 years (p<\/mml:mi>=<\/mml:mo>0.113<\/mml:mn><\/mml:math>), and at 5 years (p<\/mml:mi>=<\/mml:mo>0.114<\/mml:mn><\/mml:math>). There was no statistically significant difference between the cylinder decrease in both groups (p<\/mml:mi>=<\/mml:mo>0.349<\/mml:mn><\/mml:math> at 1 year, p<\/mml:mi>=<\/mml:mo>0.6782<\/mml:mn><\/mml:math> at 2 years, p<\/mml:mi>=<\/mml:mo>0.299<\/mml:mn><\/mml:math> at 3 years, p<\/mml:mi>=<\/mml:mo>0.0943<\/mml:mn><\/mml:math> at 4 years, and p<\/mml:mi>=<\/mml:mo>0.144<\/mml:mn><\/mml:math> at 5 years). The BCVA values were statistically significantly higher than the preoperative values in both groups at all time points (p<\/mml:mi><<\/mml:mo>0.05<\/mml:mn><\/mml:math>). Topographical indices such as thinnest corneal point (TP), corneal volume (CV), index vertical asymmetry (IVA), index of vertical asymmetry (ISV), index of height asymmetry (IHA), index of height decentration (IHD), Belin\/Ambrosio Enhanced Ectasia Display (BAD_D), and Ambrosio retinal thickness (ART Max) were significantly statistically decreased compared with baseline at all time points, in both groups. Conclusion<\/jats:italic>. \u201cEpi-off\u201d accelerated and conventional CXL have the same efficacy in terms of improvement in visual and topographic outcomes.<\/jats:p>","DOI":"10.1155\/2020\/4745101","type":"journal-article","created":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T23:32:53Z","timestamp":1595547173000},"page":"1-13","source":"Crossref","is-referenced-by-count":16,"title":["Comparative Results of \u201cEpi-Off\u201d Conventional versus \u201cEpi-Off\u201d Accelerated Cross-Linking Procedure at 5-year Follow-Up"],"prefix":"10.1155","volume":"2020","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3222-6448","authenticated-orcid":true,"given":"Cristina Ariadna","family":"Nicula","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania"},{"name":"Oculens Clinic, Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4180-7949","authenticated-orcid":true,"given":"Dorin","family":"Nicula","sequence":"additional","affiliation":[{"name":"Oculens Clinic, Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3237-6200","authenticated-orcid":true,"given":"Anca Maria","family":"Rednik","sequence":"additional","affiliation":[{"name":"County Eye Hospital, Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7748-382X","authenticated-orcid":true,"given":"Adriana Elena","family":"Bulboac\u0103","sequence":"additional","affiliation":[{"name":"Department of Physiopathology, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, Cluj-Napoca, 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