{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T18:18:35Z","timestamp":1787854715780,"version":"build-2784847793"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Glaukos"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmol Eye Dis"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Corneal cross-linking (CXL) is a safe and effective procedure for slowing keratectasia progression in eyes with a corneal thickness of at least 400\u2009\u00b5m. Limited research has evaluated the safety and efficacy of epi-off CXL in corneas thinner than 400\u2009\u00b5m.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the safety and efficacy of CXL to slow keratectasia progression in eyes with &lt;400\u2009\u00b5m preoperative corneal thickness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective chart review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This retrospective chart review included 37 eyes who underwent epi-off, iso-osmolar riboflavin corneal CXL with a preoperative thinnest point of the cornea &lt;400\u2009\u00b5m and had at least 6\u201312\u2009months of follow-up. Preoperative and postoperative uncorrected visual acuity, best-corrected visual acuity (BCVA), thinnest point of the cornea, flat keratometry, steep keratometry, maximum keratometry (K\n                      <jats:sub>max<\/jats:sub>\n                      ), need for penetrating keratoplasty, and cases of endothelial failure were recorded. Data were collected at baseline and months 3, 6, 9, and 12 post-CXL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Following cross-linking, 18 eyes (47%) had improved BCVA, 13 (35%) had an unchanged BCVA, and 6 eyes (16%) had a worse BCVA ( p\u2009=\u20090.05). The mean postoperative BCVA was 20\/81 (0.61 LogMAR) compared to 20\/121 (0.78 LogMAR) preoperatively ( p\u2009=\u20090.06). K\n                      <jats:sub>max<\/jats:sub>\n                      decreased an average of 1.1\u2009D at 3-month ( p\u2009=\u20090.53) and 3.4\u2009D at the furthest follow-up ( p\u2009=\u20090.10). At the farthest follow-up, 22.7% of eyes had &gt;1\u2009D of K\n                      <jats:sub>max<\/jats:sub>\n                      steepening. No patients required keratoplasty and there were no cases of endothelial failure in the follow-up period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      This research supports the safety and efficacy of epi-off, iso-osmolar CXL in eyes with &lt;400\u2009\u03bcm baseline corneal thickness with no patients requiring penetrating or endothelial keratoplasty, a trend toward improvement in BCVA, and K\n                      <jats:sub>max<\/jats:sub>\n                      flattening. In the future, prospective studies would be helpful to confirm these findings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/25158414231197064","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T11:59:56Z","timestamp":1694779196000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Evaluating the safety and efficacy of epi-off corneal cross-linking in patients with thin corneas due to keratectasia"],"prefix":"10.1177","volume":"15","author":[{"given":"Abigail","family":"Nieuwsma","sequence":"first","affiliation":[{"name":"University of Texas Health, San Antonio, TX, USA"},{"name":"University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8038-3934","authenticated-orcid":false,"given":"Brandon L.","family":"Vander 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