{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:42:36Z","timestamp":1791250956672,"version":"4.1.0"},"reference-count":39,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T00:00:00Z","timestamp":1604275200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Ophthalmology"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To study the corneal flattening effect of cross-linking (CXL) overtime and to look for a potential association with preoperative topographic variables and the central depth of demarcation line (DDL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>201 eyes of 146 patients (mean age of 31.2 \u00b1 7.3\u2009years) with progressive keratoconus who underwent CXL between June 2007 and December 2012 were enrolled in this retrospective study. Follow-up visits were performed at different time intervals for at least 5\u2009years. Preoperative parameters and depth of demarcation line were collected from LaserVision ophthalmology center in Lebanon. Corneal flattening was defined by a change in postoperative Kmax (\u0394Kmax) greater than 1.00 D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\u0394Kmax increased from 50.25% to 61.69%, from first to last follow-up visits. The only factor significantly correlated to \u0394Kmax during all follow-up visits was preoperative maximum keratometry (Kmax) especially when greater than 50.00 D (OR, 1.92; 95% CI, 1.10\u20133.34). All eyes showed a corneal demarcation line (mean central depth (DDL): 217.11 \u00b1 26.54\u2009\u03bcm), with no statistically significant correlation between DDL and \u0394Kmax.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>CXL effect on cornea can be cumulative overtime and delayed flattening occurs in some cases. \u0394Kmax is positively correlated with preoperative Kmax and no association was found between \u0394Kmax and DDL. Therefore, DDL may not be a valid measure for the efficacy of CXL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1120672120964080","type":"journal-article","created":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T05:56:02Z","timestamp":1604296562000},"page":"1525-1531","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Corneal flattening following collagen crosslinking for keratoconus: Findings at 5-year follow-up"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3922-360X","authenticated-orcid":false,"given":"Sandra","family":"Hoyek","sequence":"first","affiliation":[{"name":"Saint Joseph University, Faculty of Medicine, Beirut, 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