{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:00:52Z","timestamp":1791392452445,"version":"4.3.3"},"reference-count":31,"publisher":"SLACK, Inc.","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Refract Surg"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To present the 1-year results of a novel epitheliumon corneal cross-linking (epi-on CXL) protocol for the treatment of progressive keratoconus that does not require supplemental oxygen or iontophoresis and that involves the use of a modified penetration enhancer solution to enable riboflavin to saturate the corneal stroma transepithelially.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Thirty-eight eyes from 29 patients with progressive keratoconus were included. Patients were treated with epi-on CXL using accelerated pulsed high-fluence ultraviolet-A irradiation. The main outcome measures included the thinnest corneal thickness, the anterior radius of curvature in the 3-mm zone centered on the thinnest location of the cornea (ARC3mm), demarcation line depth, the final deviation value D of the Belin\/Ambr\u00f3sio Enhanced Ectasia Display (D), maximum anterior keratometry (K\n                      <jats:sub>max<\/jats:sub>\n                      ), and the apical keratoscopy (K\n                      <jats:sup>f<\/jats:sup>\n                      <jats:sub>max<\/jats:sub>\n                      ). The follow-up period was 1 month for the demarcation line depth and 1 year for all other parameters.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Differences before and after epi-on CXL were \u0394thinnest corneal thickness (\u22127.92 \u00b5m [445.29 \u00b5m, 437.37 \u03bcm],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .28), \u0394ARC (\u22120.03 mm [6.80 mm, 6.77 mm],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .57), demarcation line depth was 217.85 \u00b5m, \u0394D (Belin\/Ambr\u00f3sio) (0.17 [9.96, 10.13],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .68), \u0394Kmax (\u22120.01 D [56.12 D, 56.11 D],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .99), \u0394K\n                      <jats:sup>f<\/jats:sup>\n                      <jats:sub>max<\/jats:sub>\n                      (\u22121.41 D [57.64 D, 56.23 D],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .24).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This new epi-on CXL approach demonstrated 12-month topographic stability in progressive keratoconus without requiring supplemental oxygen or iontophoresis. This simplification holds the potential to enable a practical, office-based approach to epi-on cross-linking.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3928\/1081597x-20260802-01","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:44:06Z","timestamp":1791391446000},"source":"Crossref","is-referenced-by-count":0,"title":["Epithelium-on Corneal Cross-linking Using a Modified Penetration Enhancer Without Supplemental Oxygen or Iontophoresis"],"prefix":"10.3928","volume":"42","author":[{"given":"Farhad","family":"Hafezi","sequence":"first","affiliation":[{"name":"ELZA Institute, Dietikon, Switzerland"},{"name":"Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland;"},{"name":"USC Roski Eye Institute, University of Southern California, Los Angeles, California;"},{"name":"National Eye Institute of Uzbekistan, Tashkent, Uzbekistan;"},{"name":"Faculty of Medicine, University of Geneva, Geneva, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Enes","family":"Aydemir","sequence":"additional","affiliation":[{"name":"ELZA Institute, Dietikon, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hillen","sequence":"additional","affiliation":[{"name":"ELZA Institute, Dietikon, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00e9onard","family":"Kollros","sequence":"additional","affiliation":[{"name":"ELZA Institute, Dietikon, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki L.","family":"Hafezi","sequence":"additional","affiliation":[{"name":"ELZA Institute, Dietikon, Switzerland"},{"name":"Department of Ophthalmology, New York University Grossman School of Medicine, New York University, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan-Ji","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shady T.","family":"Awwad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihao","family":"Chen","sequence":"additional","affiliation":[{"name":"Eye Hospital of Wenzhou Medical University, Wenzhou, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio A.","family":"Torres-Netto","sequence":"additional","affiliation":[{"name":"ELZA Institute, Dietikon, Switzerland"},{"name":"Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, 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