{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T06:04:47Z","timestamp":1776319487404,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"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 investigate the outcomes of accelerated (A-CXL) and iontophoresis (I-CXL) corneal crosslinking in a large retrospective cohort with progressive keratoconus. Methods: This retrospective observational cohort study included consecutive patients treated by A-CXL (9 mW\/5.4 J\/cm2) or I-CXL with a minimal follow-up of 12 months. Visual acuity, manifest refraction, topography, specular microscopy, and corneal optical coherence tomography (OCT) were evaluated at baseline and at the last visit. Progression was defined as an increase in the maximum topographic keratometry (Kmax) of 1D. Results: 302 eyes of 241 patients with a mean age of 25.2 \u00b1 7.5 years were included from 2012 to 2019: 231 and 71 eyes in the A-CXL and I-CXL groups, respectively. The mean follow-up was 27.2 \u00b1 13.2 months (maximum: 85.7 months). Preoperatively, the mean Kmax was 51.8 \u00b1 4.0D, with no differences between groups. Mean topographic measurements and spherical equivalent remained stable during the follow-up. At the last visit, CXL failure was reported in 60 eyes (19.9%): 40 (14.7%) versus 20 (28.2%) in A-CXL versus I-CXL, respectively, p = 0.005. The likelihood of progression after CXL was significantly higher following I-CXL: RR = 1.62, CI95 = [1.02 to 2.59], p = 0.04. Demarcation line presence at 1 month was positively correlated with higher efficacy of CXL, p = 0.03. No endothelial damage was reported, especially in 51 thin corneas (range = 342\u2013399 \u00b5m). Conclusions: A-CXL seems more effective than I-CXL in stabilizing keratoconus; this is to be taken into account when a therapeutic indication is posed according to the aggressiveness of the keratoconus.<\/jats:p>","DOI":"10.3390\/jcm12082931","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T05:18:13Z","timestamp":1681795093000},"page":"2931","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Efficacy, Safety, and Outcomes following Accelerated and Iontophoresis Corneal Crosslinking in Progressive Keratoconus"],"prefix":"10.3390","volume":"12","author":[{"given":"Sami","family":"Saad","sequence":"first","affiliation":[{"name":"CHNO Des Quinze-Vingts, IHU ForeSight, INSERM-DGOS CIC 1423, 28 Rue de Charenton, F-75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6337-8356","authenticated-orcid":false,"given":"Rana","family":"Saad","sequence":"additional","affiliation":[{"name":"CHNO Des Quinze-Vingts, IHU ForeSight, INSERM-DGOS CIC 1423, 28 Rue de Charenton, F-75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Goemaere","sequence":"additional","affiliation":[{"name":"CHNO Des Quinze-Vingts, IHU ForeSight, INSERM-DGOS CIC 1423, 28 Rue de Charenton, F-75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxane","family":"Cuyaubere","sequence":"additional","affiliation":[{"name":"CHNO Des Quinze-Vingts, IHU ForeSight, INSERM-DGOS CIC 1423, 28 Rue de Charenton, F-75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Borderie","sequence":"additional","affiliation":[{"name":"CHNO Des Quinze-Vingts, IHU ForeSight, INSERM-DGOS CIC 1423, 28 Rue de Charenton, F-75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1395-8483","authenticated-orcid":false,"given":"Vincent","family":"Borderie","sequence":"additional","affiliation":[{"name":"CHNO Des Quinze-Vingts, IHU ForeSight, INSERM-DGOS CIC 1423, 28 Rue de Charenton, F-75012 Paris, France"},{"name":"Sorbonne Universit\u00e9, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nacim","family":"Bouheraoua","sequence":"additional","affiliation":[{"name":"CHNO Des Quinze-Vingts, IHU ForeSight, INSERM-DGOS CIC 1423, 28 Rue de Charenton, F-75012 Paris, France"},{"name":"Sorbonne Universit\u00e9, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0039-6257(97)00119-7","article-title":"Keratoconus","volume":"42","author":"Rabinowitz","year":"1998","journal-title":"Surv. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/S0002-9394(02)02220-1","article-title":"Riboflavin\/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus","volume":"135","author":"Wollensak","year":"2003","journal-title":"Am. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2147\/OPTH.S27170","article-title":"Long term results of a prospective randomized bilateral eye comparison trial of higher fluence, shorter duration ultraviolet A radiation, and riboflavin collagen cross linking for progressive keratoconus","volume":"6","author":"Kanellopoulos","year":"2012","journal-title":"Clin. Ophthalmol. Auckl. NZ"},{"key":"ref_4","first-page":"30","article-title":"Transepithelial corneal collagen cross-linking by iontophoresis of riboflavin","volume":"92","author":"Bikbova","year":"2013","journal-title":"Acta Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/ICO.0000000000001062","article-title":"Conventional and Iontophoresis Corneal Cross-Linking for Keratoconus: Efficacy and Assessment by Optical Coherence Tomography and Confocal Microscopy","volume":"36","author":"Jouve","year":"2017","journal-title":"Cornea"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e600","DOI":"10.1111\/aos.13032","article-title":"Standard corneal collagen crosslinking versus transepithelial iontophoresis-assisted corneal crosslinking, 24 months follow-up: Randomized control trial","volume":"94","author":"Bikbova","year":"2016","journal-title":"Acta Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Vinciguerra, R., Legrottaglie, E.F., Tredici, C., Mazzotta, C., Rosetta, P., and Vinciguerra, P. (2022). Transepithelial Iontophoresis-Assisted Cross Linking for Progressive Keratoconus: Up to 7 Years of Follow Up. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030678"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40662-021-00240-8","article-title":"Long term results of accelerated 9\u2009mW corneal crosslinking for early progressive keratoconus: The Siena Eye-Cross Study 2","volume":"8","author":"Mazzotta","year":"2021","journal-title":"Eye Vis."},{"key":"ref_9","first-page":"15","article-title":"Safety and efficacy of epithelium removal and transepithelial corneal collagen crosslinking for keratoconus","volume":"29","author":"Shalchi","year":"2015","journal-title":"Eye Lond. Engl."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ajo.2020.01.006","article-title":"Accelerated corneal cross-linking: Efficacy, risk of progression, and characteristics affecting outcomes. A large single-centre prospective study","volume":"213","author":"Hatch","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/j.jcrs.0000000000000049","article-title":"Comparison of accelerated CXL alone, accelerated CXL-ICRS, and accelerated CXL-TG-PRK in progressive keratoconus and other corneal ectasias","volume":"46","author":"Singal","year":"2020","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ajo.2011.05.036","article-title":"Corneal collagen cross-linking with riboflavin and ultraviolet-A irradiation in patients with thin corneas","volume":"153","author":"Kymionis","year":"2012","journal-title":"Am. J. Ophthalmol."},{"key":"ref_13","first-page":"1","article-title":"National survey of corneal cross-linking (CXL) practice patterns in the United Kingdom during 2019","volume":"20","author":"Hayes","year":"2022","journal-title":"Eye Lond. Engl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ajo.2011.01.016","article-title":"Corneal cross-linking with hypo-osmolar riboflavin solution in thin keratoconic corneas","volume":"152","author":"Raiskup","year":"2011","journal-title":"Am. J. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.2147\/OPTH.S37335","article-title":"Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas","volume":"6","author":"Spadea","year":"2012","journal-title":"Clin. Ophthalmol. Auckl. NZ"},{"key":"ref_16","first-page":"41","article-title":"Factors affecting outcomes of corneal collagen crosslinking treatment","volume":"28","author":"Toprak","year":"2014","journal-title":"Eye Lond. Engl."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/j.jcrs.2009.03.035","article-title":"Complication and failure rates after corneal crosslinking","volume":"35","author":"Koller","year":"2009","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.ajo.2013.11.001","article-title":"A multivariate analysis and statistical model for predicting visual acuity and keratometry one year after cross-linking for keratoconus","volume":"157","author":"Wisse","year":"2014","journal-title":"Am. J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.jcrs.2013.06.007","article-title":"Characteristics influencing outcomes of corneal collagen crosslinking for keratoconus and ectasia: Implications for patient selection","volume":"39","author":"Greenstein","year":"2013","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1016\/j.jcrs.2016.08.017","article-title":"Effect of preoperative factors on visual acuity, corneal flattening, and corneal haze after accelerated corneal crosslinking","volume":"42","author":"Koc","year":"2016","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7601","DOI":"10.1167\/iovs.14-15662","article-title":"Optical coherence tomography and confocal microscopy following three different protocols of corneal collagen-crosslinking in keratoconus","volume":"55","author":"Bouheraoua","year":"2014","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_22","first-page":"219","article-title":"Clinical and microstructural changes with different iontophoresis-assisted corneal cross-linking methods for keratoconus","volume":"12","author":"Liao","year":"2019","journal-title":"Int. J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7908","DOI":"10.1167\/iovs.15-17569","article-title":"A Comparison of Different Corneal Iontophoresis Protocols for Promoting Transepithelial Riboflavin Penetration","volume":"56","author":"Gore","year":"2015","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"438","DOI":"10.3928\/1081597X-20180515-02","article-title":"Enhanced-Fluence Pulsed-Light Iontophoresis Corneal Cross-linking: 1-Year Morphological and Clinical Results","volume":"34","author":"Mazzotta","year":"2018","journal-title":"J. Refract. Surg."},{"key":"ref_25","first-page":"286","article-title":"Iontophoresis Corneal Cross-linking With Enhanced Fluence and Pulsed UV-A Light","volume":"36","author":"Mazzotta","year":"2020","journal-title":"J. Refract. Surg. Thorofare NJ 1995"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1080\/02713683.2019.1669663","article-title":"Optimization of Oxygen Dynamics, UV-A Delivery, and Drug Formulation for Accelerated Epi-On Corneal Crosslinking","volume":"45","author":"Hill","year":"2020","journal-title":"Curr. Eye Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/2931\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:18:02Z","timestamp":1760123882000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/2931"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,18]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jcm12082931"],"URL":"https:\/\/doi.org\/10.3390\/jcm12082931","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,18]]}}}