{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:21:49Z","timestamp":1791436909036,"version":"4.3.3"},"reference-count":33,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2022,8,27]],"date-time":"2022-08-27T00:00:00Z","timestamp":1661558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: To assess the 3-year clinical results of the 18 mW 7 J\/cm2 transepithelial enhanced fluence pulsed light M accelerated crosslinking in the treatment of progressive keratoconus (KC) with chemically enhanced hyper-concentrated riboflavin solutions without iontophoresis and with air-room oxygenation. Setting: Siena Crosslinking Center, Siena, Italy. Methods: Prospective pilot, open non-randomized interventional study including 40 eyes of 30 young adult patients over 21 years old (10 simultaneous bilateral) with early (Stage I and II) progressive KC undergoing TE-EFPL 18 mW\/7 J\/cm2 ACXL (EFPL M TECXL). The 12 min and 58 s pulsed light (1 s on\/1 s off) UV-A exposure treatments were performed with a biphasic corneal soaking using Paracel I 0.25% for 4 min and Paracel II 0.22% for 6 min riboflavin solutions and New KXL I UV-A emitter (Glaukos-Avedro, Waltham, USA) at an air room of 21% oxygenation. All patients completed the 3-year follow-up. Results: CDVA showed a statistically significant improvement in the third postoperative month (\u0394 + 0.17 d. e.) with a final gain of +0.22 d. eq. AK showed a statistically significant decrease in the sixth postoperative month (\u0394 \u2212 1.15 diopters). K itmax showed a statistically significant decrease at 1-year follow-up (\u0394 \u2212 1.3 diopters). The coma value improved significantly by the sixth month (\u0394 \u2212 0.54 \u00b5m). MCT remained stable during the entire follow-up. No adverse events were recorded. Corneal OCT revealed a mean demarcation line depth at 282.6 \u00b1 23.6 \u03bcm. Conclusions: Transepithelial enhanced fluence pulsed light M accelerated crosslinking with chemically enhanced riboflavin solution halted KC progression in young adult patients without iontophoresis and no intraoperative oxygen supplementation addressing the importance of increased fluence.<\/jats:p>","DOI":"10.3390\/jcm11175039","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T03:34:56Z","timestamp":1661744096000},"page":"5039","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Transepithelial Enhanced Fluence Pulsed Light M Accelerated Crosslinking for Early Progressive Keratoconus with Chemically Enhanced Riboflavin Solutions and Air Room Oxygen"],"prefix":"10.3390","volume":"11","author":[{"given":"Cosimo","family":"Mazzotta","sequence":"first","affiliation":[{"name":"Departmental Ophthalmology Unit, Alta Val d\u2019 Elsa Hospital, USL Toscana Sudest, Post Graduate Ophthalmology School, University of Siena, Siena Crosslinking Center Siena Italy, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0679-9688","authenticated-orcid":false,"given":"Ashraf Armia","family":"Balamoun","sequence":"additional","affiliation":[{"name":"Watany Research and Development Center, Ashraf Armia Eye Clinic and Al Watany Eye Hospital, Cairo 11511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0593-8180","authenticated-orcid":false,"given":"Ayoub","family":"Chabib","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Cornea and Refractive Surgery, San Rossore Medical Center, 56122 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Rechichi","sequence":"additional","affiliation":[{"name":"Centro Polispecialistico Mediterraneo, 88050 Sellia Marina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5702-8595","authenticated-orcid":false,"given":"Francesco","family":"D\u2019Oria","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Santa Maria Hospital-GVM, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8935-4558","authenticated-orcid":false,"given":"Farhad","family":"Hafezi","sequence":"additional","affiliation":[{"name":"ELZA InsZurich, 8953 Dietikon, Switzerland"},{"name":"Laboratory for Ocular Cell Biology, University of Zurich, 8006 Zurich, Switzerland"},{"name":"Roski Eye Institute, University of Southern California, Los Angeles, CA 90001, USA"},{"name":"Department of Ophthalmology, University of Wenzhou, Wenzhou 325015, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone Alex","family":"Bagaglia","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, USL Toscana Sud-Est, 52100 Massa Marittima, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0971-8225","authenticated-orcid":false,"given":"Marco","family":"Ferrise","sequence":"additional","affiliation":[{"name":"Studio Oculistico Ferrise, 88046 Lamezia Terme, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jtos.2013.01.002","article-title":"Corneal Crosslinking with Riboflavin and Ultraviolet A. 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