{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T17:33:57Z","timestamp":1767893637489,"version":"3.49.0"},"reference-count":30,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"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>Background: Contact lens-assisted corneal cross-linking can be used to treat keratoconus in patients with thin corneas under measuring less than 400 \u00b5m. This study compares the long-term clinical and tomographic outcomes between accelerated corneal cross-linking (A-CXL) and accelerated contact lens-assisted corneal cross-linking (A-CACXL). Methods: Patients who underwent either A-CXL or A-CACXL protocol due to progressive keratoconus were enrolled in this retrospective cohort study conducted between January 2015 and December 2018. The control group (patients with minimum corneal thickness of at least 400 \u00b5m, comprising 32 eyes of from 32 patients) was treated with A-CXL, whereas the treatment group (patients that had minimum corneal thickness after epithelial removal below 400 \u00b5m; 30 eyes of from 30 patients) underwent the A-CACXL protocol. Clinical and tomographic data were obtained from a 3-year follow-up period. Results: At 3 years, both groups represented a significant gain in best-corrected visual acuity (from 0.32 to 0.18 LogMAR units for A-CXL, p = 0.001; from 0.51 to 0.33 LogMAR units for A-CACXL, p = 0.037). Furthermore, postoperative tomographic parameters (Kmax, Kmean, or corneal astigmatism) were comparable between the two protocols. Progression of keratoconus was halted among 87% of eyes in the A-CXL group and among 73% of eyes in the A-CACXL group (p = 0.2). Conclusions: A-CACXL treatment is an effective and safe option for patients with keratoconus and thin corneas, yielding long term outcomes comparable to those of A-CXL treatment for patients with a minimum corneal thickness of 400 \u00b5m following a 3-year follow-up.<\/jats:p>","DOI":"10.3390\/jcm14207141","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:47:08Z","timestamp":1760104028000},"page":"7141","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Accelerated CXL Versus Accelerated Contact-Lens Assisted CXL Treatment for Progressive Keratoconus\u2014A 3-Year Retrospective Comparative Follow-Up"],"prefix":"10.3390","volume":"14","author":[{"given":"Anna","family":"Bunin","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shmuel","family":"Kagasov","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nir","family":"Amitai","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel"},{"name":"Clinical Research Center, Soroka University Medical Center, Beer-Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8032-0111","authenticated-orcid":false,"given":"Tomer","family":"Kerman","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel"},{"name":"Clinical Research Center, Soroka University Medical Center, Beer-Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0202-4853","authenticated-orcid":false,"given":"Ran","family":"Matlov Kormas","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kaplan Medical Center, Rehovot 76100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soosan","family":"Jacob","sequence":"additional","affiliation":[{"name":"Dr. Agarwal\u2019s Refractive and Cornea Foundation, Dr. Agarwal\u2019s Eye Hospital, Chennai 600018, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1550-8125","authenticated-orcid":false,"given":"Raimo","family":"Tuuminen","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel"},{"name":"Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland"},{"name":"Eye Centre, Kymenlaakso Central Hospital, 48210 Kotka, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liron","family":"Kravitz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9246-3226","authenticated-orcid":false,"given":"Boris","family":"Knyazer","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel"},{"name":"Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101559","DOI":"10.1016\/j.clae.2021.101559","article-title":"Keratoconus: An updated review","volume":"45","author":"Carracedo","year":"2022","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s40662-016-0033-y","article-title":"Corneal surgery in keratoconus: Which type, which technique, which outcomes?","volume":"3","year":"2016","journal-title":"Eye Vis."},{"key":"ref_3","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. 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