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The mean age was 18.05\u2009\u00b1\u20095.6\u2009years. The 20-min treatments were performed using the New KXL I (Avedro, Waltham, USA), 10\u2009min of 0.1% HPMC Riboflavin soaking (VibeX Rapid, Avedro, Waltham, USA) and 10\u2009min of continuous-light UV-A irradiation. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), Kmax, coma, minimum corneal thickness (MCT), surface asymmetry index (SAI), endothelial cell count (ECC) were measured, and corneal OCT performed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>UDVA and CDVA improved significantly at the 3rd (<jats:italic>P<\/jats:italic>\u00a0=\u20090.028), \u0394\u2009+\u20090.17 Snellen lines and 6th postoperative month, respectively (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), \u0394\u2009+\u20090.23 Snellen lines. Kmax improved at the 6th postoperative month (<jats:italic>P<\/jats:italic>\u00a0=\u20090.03), \u0394\u2009\u2212\u20091.49 diopters from the baseline value. Also, coma aberration value improved significantly (<jats:italic>P<\/jats:italic>\u00a0=\u20090.004). A mild temporary haze was recorded in 14.77% of patients without affecting visual acuity and without persistent complications. Corneal OCT revealed a mean demarcation line depth at 332.6\u2009\u00b1\u200933.6\u2009\u03bcm.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The 5-year results of Epi-Off 9\u2009mW\/5.4\u2009J\/cm<jats:sup>2<\/jats:sup> ACXL demonstrated statistically significant improvements in UCVA and CDVA, corneal curvature and corneal higher-order aberrations which confers a long-term stability for progressive ectasia. Based on the results of the Siena Eye-Cross Study 2,\u00a0the 9\u2009mW\/5.4\u2009J\/cm<jats:sup>2<\/jats:sup> ACXL is a candidate to be\u00a0 the natural evolution of Epi-Off CXL treatment for the management of early progressive corneal ectasia, and thus optimize clinic workflow.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40662-021-00240-8","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T11:55:36Z","timestamp":1620042936000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":82,"title":["Long term results of accelerated 9\u2009mW corneal crosslinking for early progressive keratoconus: the Siena Eye-Cross Study 2"],"prefix":"10.1186","volume":"8","author":[{"given":"Cosimo","family":"Mazzotta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Raiskup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhad","family":"Hafezi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio A","family":"Torres-Netto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf","family":"Armia Balamoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Giannaccare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone Alex","family":"Bagaglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,1]]},"reference":[{"issue":"5","key":"240_CR1","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1016\/S0002-9394(02)02220-1","volume":"135","author":"G Wollensak","year":"2003","unstructured":"Wollensak G, Spoerl E, Seiler T. 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