{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T06:09:30Z","timestamp":1792822170798,"version":"4.5.0"},"reference-count":24,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T00:00:00Z","timestamp":1727395200000},"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>Objectives: This pilot ex vivo study and first clinical experience in Italy evaluate the impact of using pre-implantation crosslinking on all-femtosecond laser-cut corneal allogenic intracorneal ring segments (AFXL CAIRSs). Methods: Six human donor eye-bank corneas were used for this preclinical ex vivo human study. Three donor (D) corneas were used for AFXL CAIRSs. First, they were prepared with an IntraLase\u2122 femtosecond laser (Johnson &amp; Johnson, New Brunswick, NJ, USA). The allogenic tissue rings were crosslinked before implantation with Riboflavin\u2013UV-A accelerated crosslinking protocol (ACXL) with a 0.1% HPMC Riboflavin isotonic solution (Vibex Rapid, Glaukos-Avedro, Burlington, MA, USA) and a new KXL UV-A emitter (Glaukos-Avedro, USA). Three corneas were used as recipients (Rs) of the AFXL CAIRSs. After completing the ex vivo phase, IRB approval and signing a specific informed consent, the first two Italian patients were treated. A single ACXL CAIRS was implanted in a 51-year-old male with 53.53 D K steep, 363 \u03bcm minimum corneal thickness (MCT) and a double ACXL CAIRS was implanted in a 46-year-old male patient with 58.30 D K steep, 443 \u03bcm MCT. The longest follow-up was at three months. Results: Crosslinking of the segments enhanced tissue stiffness and grip, facilitating manipulation and CAIRS insertion into the recipient tunnels, and the yellowish color of the crosslinked segments improved visibility. The segment\u2019s thickness and volume remained unaltered during the follow-up. Both patients improved UDVA and BSCVA. K steep and High-Order Aberrations (HOAs) were reduced and MCT increased. Conclusions: Pre-implantation ACXL facilitated CAIRS insertion preserving dimensions and volume during the follow-up, rendering this important step a promising candidate in method standardization. Functional data and MCT improved significantly without adverse events.<\/jats:p>","DOI":"10.3390\/jcm13195771","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T07:49:24Z","timestamp":1727423364000},"page":"5771","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Crosslinked All-Femtosecond Laser-Cut Corneal Allogenic Intracorneal Ring Segments (AFXL CAIRSs): Pilot Ex Vivo Study and Report of First Two Cases Performed in Italy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1829-9288","authenticated-orcid":false,"given":"Cosimo","family":"Mazzotta","sequence":"first","affiliation":[{"name":"Department of Medicine, Surgery and Neurosciences, Postgraduate Ophthalmology School, Siena University, 53035 Siena, Italy"},{"name":"Departmental Ophthalmology Unit, AUSL Toscana Sud Est, 53035 Siena, Italy"},{"name":"Siena Crosslinking Center, 53035 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Zagari","sequence":"additional","affiliation":[{"name":"Vampolieri Eye Clinic, 95021 Castello, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Bona","sequence":"additional","affiliation":[{"name":"Vampolieri Eye Clinic, 95021 Castello, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Ponzin","sequence":"additional","affiliation":[{"name":"Veneto Eye Bank Foundation, 30174 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shady T.","family":"Awwad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, American University of Beirut-Medical Center, Beirut 1107-2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio A.","family":"Torres-Netto","sequence":"additional","affiliation":[{"name":"ELZA Institute, 8953 Dietikon, Switzerland"},{"name":"Ocular Cell Biology Laboratory, University of Zurich, 8001 Zurich, Switzerland"}],"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 Institute, 8953 Dietikon, Switzerland"},{"name":"Ocular Cell Biology Laboratory, University of Zurich, 8001 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soosan","family":"Jacob","sequence":"additional","affiliation":[{"name":"Department of Cornea, Dr. Agarwal\u2019s Eye Hospital and Eye Research Centre, Chennai 600018, India"},{"name":"Department of Cornea, Dr. Agarwal\u2019s Refractive and Cornea Foundation, Chennai 600006, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"296","DOI":"10.3928\/1081597X-20180223-01","article-title":"Corneal allogenic intrastromal ring segments (CAIRS) combined with corneal cross-linking for keratoconus","volume":"34","author":"Jacob","year":"2018","journal-title":"J. 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