{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:34:14Z","timestamp":1787758454335,"version":"build-2784847793"},"reference-count":75,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>PURPOSE:<\/jats:title>\n                    <jats:p>The purpose of the study is to evaluate the safety and outcomes of corneal collagen cross-linking (CXL) and different CXL protocols in progressive keratoconus (PK) population at short and long-term.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>\n                      A systematic review and meta-analysis was conducted. A total of eight literature databases were searched (up to February 15, 2022). Randomized controlled trials (RCTs) comparing CXL versus placebo\/control or comparing different CXL protocols in the PK population were included. The primary objective was assessment of outcomes of CXL versus placebo and comparison of different CXL protocols in terms of maximum keratometry (Kmax) or Kmax change from baseline (\u0394), spherical equivalent, best corrected visual acuity (BCVA), and central corneal thickness (CCT) in both at short term (6 months) and long term (1\n                      <jats:sup>st<\/jats:sup>\n                      , 2\n                      <jats:sup>nd<\/jats:sup>\n                      , and 3\n                      <jats:sup>rd<\/jats:sup>\n                      year or more). The secondary objective was comparative evaluation of safety. For the meta-analysis, the RevMan5.3 software was used.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>A total of 48 RCTs were included. Compared to control, CXL was associated with improvement in \u0394 Kmax at 1 year (4 RCTs, mean difference [MD], \u22121.78 [\u22122.71, \u22120.86], P = 0.0002) and 2 and 3 years (1 RCT); \u0394BCVA at 1 year (7 RCTs, \u22120.10 [\u22120.14, \u22120.06], P &lt; 0.00001); and \u0394 CCT at 1 year (2 RCTs) and 3 years (1 RCT). Compared to conventional CXL (C-CXL), deterioration in \u0394 Kmax, \u0394BCVA and endothelial cell density was seen at long term in the transepithelial CXL (TE-CXL, chemical enhancer). Up to 2 years, there was no difference between TE-CXL using iontophoresis (T-ionto) and C-CXL. At 2 and 4 years, C-CXL performed better compared to accelerated CXL (A-CXL) in terms of improving Kmax. Although CCT was higher in the A-CXL arm at 2 years, there was no difference at 4 years. While exploring heterogeneity among studies, selection of control eye (fellow eye of the same patient vs. eye of different patient) and baseline difference in Kmax were important sources of heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>CXL outperforms placebo\/control in terms of enhancing Kmax and CCT, as well as slowing disease progression over time (till 3 years). T-ionto protocol, on the other hand, performed similarly to C-CXL protocol up to 2 years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/2211-5056.361974","type":"journal-article","created":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T07:01:11Z","timestamp":1669359671000},"page":"191-202","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":18,"title":["Short- and long-term safety and efficacy of corneal collagen cross-linking in progressive keratoconus: A systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.4103","volume":"13","author":[{"given":"Phulen","family":"Sarma","sequence":"first","affiliation":[{"name":"Department of Pharmacology, All India Institute of Medical Sciences, Guwahati, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hardeep","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhad","family":"Hafezi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, ELZA, Institute, Webereistrasse, Dietikon, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaimini","family":"Bhattacharyya","sequence":"additional","affiliation":[{"name":"Department of Management Studies, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Kirubakaran","sequence":"additional","affiliation":[{"name":"Centre for Biostatistics and Evidence Based Medicine, Nellore, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manisha","family":"Prajapat","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bikash","family":"Medhi","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyan","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subodh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dibbanti Harikrishna","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Central University of Punjab, Bathinda, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurjeet","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, PGIMER, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anusuya","family":"Bhattacharyya","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Government Medical College and Hospital, Sector 32, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,11,28]]},"reference":[{"key":"R1-20240830","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/0039-6257(84)90094-8","article-title":"Keratoconus and related noninflammatory corneal thinning disorders","volume":"28","author":"Krachmer","year":"1984","journal-title":"Surv Ophthalmol"},{"key":"R2-20240830","doi-asserted-by":"crossref","first-page":"157","DOI":"10.4103\/ijp.IJP_75_19","article-title":"Safety and efficacy of riboflavin-assisted collagen cross-linking of cornea in progressive keratoconus patients:A prospective study in North East India","volume":"51","author":"Bhattacharyya","year":"2019","journal-title":"Indian J Pharmacol"},{"key":"R3-20240830","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12886-015-0070-7","article-title":"Prospective, randomized, double-blind trial to investigate the efficacy and safety of corneal cross-linking to halt the progression of keratoconus","volume":"15","author":"Lang","year":"2015","journal-title":"BMC Ophthalmol"},{"key":"R4-20240830","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":"R5-20240830","doi-asserted-by":"crossref","first-page":"e025728","DOI":"10.1136\/bmjopen-2018-025728","article-title":"Transepithelial versus epithelium-off corneal collagen cross-linking for corneal ectasia:Protocol for a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials","volume":"9","author":"Nath","year":"2019","journal-title":"BMJ Open"},{"issue":"Suppl 10","key":"R6-20240830","first-page":"S53","article-title":"Transepithelial versus epithelium-off corneal collagen cross-linking for progressive keratoconus:A prospective randomized controlled trial","volume":"34","author":"Al","year":"2015","journal-title":"Cornea"},{"key":"R7-20240830","doi-asserted-by":"crossref","first-page":"503","DOI":"10.2147\/OPTH.S73991","article-title":"Standard versus trans-epithelial collagen cross-linking in keratoconus patients suitable for standard collagen cross-linking","volume":"9","author":"Rossi","year":"2015","journal-title":"Clin Ophthalmol Auckl NZ"},{"key":"R8-20240830","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.ajo.2015.02.005","article-title":"Transepithelial versus epithelium-off corneal cross-linking for the treatment of progressive keratoconus:A randomized controlled trial","volume":"159","author":"Soeters","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"R9-20240830","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1007\/s00417-018-3966-0","article-title":"Current perspectives on corneal collagen crosslinking (CXL)","volume":"256","author":"Subasinghe","year":"2018","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"R10-20240830","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1111\/aos.12380","article-title":"Initial results from mechanical compression of the cornea during crosslinking for keratoconus","volume":"92","author":"Beckman","year":"2014","journal-title":"Acta Ophthalmol"},{"key":"R11-20240830","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1136\/bjophthalmol-2016-309210","article-title":"Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus:1-year results","volume":"101","author":"Nordstr\u00f6m","year":"2017","journal-title":"Br J Ophthalmol"},{"key":"R12-20240830","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1016\/j.jcrs.2014.02.036","article-title":"Epithelial remodeling after partial topography-guided normalization and high-fluence short-duration crosslinking (Athens protocol):Results up to 1 year","volume":"40","author":"Kanellopoulos","year":"2014","journal-title":"J Cataract Refract Surg"},{"key":"R13-20240830","doi-asserted-by":"crossref","first-page":"795","DOI":"10.2147\/OPTH.S188519","article-title":"The impact of keratoconus treatment with the Athens Protocol (partial topography-guided photorefractive keratectomy combined with higher-fluence corneal collagen cross-linking) on quality of life:A long-term study","volume":"13","author":"Kanellopoulos","year":"2019","journal-title":"Clin Ophthalmol"},{"key":"R14-20240830","doi-asserted-by":"crossref","first-page":"8145651","DOI":"10.1155\/2017\/8145651","article-title":"Corneal collagen cross-linking for keratoconus:Systematic review","volume":"2017","author":"Kobashi","year":"2017","journal-title":"Biomed Res Int"},{"key":"R15-20240830","doi-asserted-by":"crossref","first-page":"e0127079","DOI":"10.1371\/journal.pone.0127079","article-title":"Efficacy of corneal collagen cross-linking for treatment of keratoconus:A meta-analysis of randomized controlled trials","volume":"10","author":"Li","year":"2015","journal-title":"PLoS One"},{"key":"R17-20240830","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions:Explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"R18-20240830","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jcrs.2010.07.030","article-title":"Corneal collagen crosslinking for keratoconus and corneal ectasia:One-year results","volume":"37","author":"Hersh","year":"2011","journal-title":"J Cataract Refract Surg"},{"key":"R19-20240830","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1002\/jmv.25898","article-title":"Virological and clinical cure in COVID-19 patients treated with hydroxychloroquine:A systematic review and meta-analysis","volume":"92","author":"Sarma","year":"2020","journal-title":"J Med Virol"},{"key":"R21-20240830","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.2147\/NDT.S151802","article-title":"Risperidone for children and adolescents with autism spectrum disorder:A systematic review","volume":"14","author":"Maneeton","year":"2018","journal-title":"Neuropsychiatr Dis Treat"},{"key":"R22-20240830","first-page":"S720","article-title":"A randomized controlled trial of corneal collagen cross-linking in progressive keratoconus:Preliminary results","volume":"24","author":"Wittig-Silva","year":"2008","journal-title":"J Refract Surg"},{"key":"R23-20240830","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/ICL.0000000000000090","article-title":"Effects of corneal cross-linking on ocular response analyzer waveform-derived variables in keratoconus and postrefractive surgery ectasia","volume":"40","author":"Hallahan","year":"2014","journal-title":"Eye Contact Lens"},{"key":"R24-20240830","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.ophtha.2013.10.028","article-title":"A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus:Three-year results","volume":"121","author":"Wittig-Silva","year":"2014","journal-title":"Ophthalmology"},{"key":"R25-20240830","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1016\/j.ophtha.2017.03.052","article-title":"United States Multicenter Clinical Trial of Corneal Collagen Crosslinking for Keratoconus Treatment","volume":"124","author":"Hersh","year":"2017","journal-title":"Ophthalmology"},{"key":"R26-20240830","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.jcrs.2016.01.040","article-title":"Intraoperative corneal thickness change and clinical outcomes after corneal collagen crosslinking:Standard crosslinking versus hypotonic riboflavin","volume":"42","author":"Rosenblat","year":"2016","journal-title":"J Cataract Refract Surg"},{"key":"R27-20240830","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jcrs.2011.08.041","article-title":"Higher-order aberrations after corneal collagen crosslinking for keratoconus and corneal ectasia","volume":"38","author":"Greenstein","year":"2012","journal-title":"J Cataract Refract Surg"},{"key":"R28-20240830","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/j.jcrs.2011.01.029","article-title":"Corneal topography indices after corneal collagen crosslinking for keratoconus and corneal ectasia:One-year results","volume":"37","author":"Greenstein","year":"2011","journal-title":"J Cataract Refract Surg"},{"key":"R29-20240830","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1136\/bjo.2010.196493","article-title":"A randomised, prospective study to investigate the efficacy of riboflavin\/ultraviolet A (370 nm) corneal collagen cross-linkage to halt the progression of keratoconus","volume":"95","author":"O'Brart","year":"2011","journal-title":"Br J Ophthalmol"},{"key":"R30-20240830","doi-asserted-by":"crossref","first-page":"340","DOI":"10.4103\/0974-9233.159755","article-title":"Corneal collagen cross-linking in the treatment of progressive keratoconus:A randomized controlled contralateral eye study","volume":"22","author":"Seyedian","year":"2015","journal-title":"Middle East Afr J Ophthalmol"},{"key":"R31-20240830","doi-asserted-by":"crossref","first-page":"410","DOI":"10.3928\/1081597X-20130410-02","article-title":"Localized changes in stromal reflectivity after corneal collagen cross-linking observed with different imaging techniques","volume":"29","author":"Wittig-Silva","year":"2013","journal-title":"J Refract Surg"},{"key":"R32-20240830","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ICO.0000000000002484","article-title":"Cool crosslinking:Riboflavin at 4\u00b0C for pain management after crosslinking for keratoconus patients, a randomized clinical trial","volume":"40","author":"Toro-Giraldo","year":"2021","journal-title":"Cornea"},{"key":"R33-20240830","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s10792-015-0054-x","article-title":"Collagen cross-linking in keratoconus in Asian eyes:Visual, refractive and confocal microscopy outcomes in a prospective randomized controlled trial","volume":"35","author":"Sharma","year":"2015","journal-title":"Int Ophthalmol"},{"key":"R34-20240830","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.jcrs.2016.04.019","article-title":"Natural history of corneal haze after corneal collagen crosslinking in keratoconus using Scheimpflug analysis","volume":"42","author":"Kim","year":"2016","journal-title":"J Cataract Refract Surg"},{"key":"R35-20240830","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/ICO.0b013e3181eeaea1","article-title":"Riboflavin\/ultraviolet A corneal collagen cross-linking for the treatment of keratoconus:Visual outcomes and scheimpflug analysis","volume":"30","author":"Henriquez","year":"2011","journal-title":"Cornea"},{"key":"R36-20240830","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1111\/ceo.13959","article-title":"Five-year results of a prospective, randomised, contralateral eye trial of corneal crosslinking for keratoconus","volume":"49","author":"Meyer","year":"2021","journal-title":"Clin Exp Ophthalmol"},{"key":"R37-20240830","doi-asserted-by":"crossref","first-page":"619398","DOI":"10.1155\/2014\/619398","article-title":"Corneal collagen cross-linking with and without epithelial removal:A contralateral study with 0.5% hypotonic riboflavin solution","volume":"2014","author":"Stojanovic","year":"2014","journal-title":"Biomed Res Int"},{"key":"R39-20240830","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1097\/ICO.0000000000002334","article-title":"Corneal haze after transepithelial collagen cross-linking for keratoconus:A scheimpflug densitometry analysis","volume":"39","author":"Lai","year":"2020","journal-title":"Cornea"},{"key":"R40-20240830","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jcrs.2017.12.022","article-title":"Transepithelial corneal crosslinking for keratoconus","volume":"44","author":"Hersh","year":"2018","journal-title":"J Cataract Refract Surg"},{"key":"R41-20240830","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/0974-620X.149855","article-title":"Trans-epithelial versus conventional corneal collagen crosslinking:A randomized trial in keratoconus","volume":"8","author":"Nawaz","year":"2015","journal-title":"Oman J Ophthalmol"},{"key":"R42-20240830","doi-asserted-by":"crossref","first-page":"8","DOI":"10.2174\/1874364101913010008","article-title":"Transepithelial versus epithelium off crosslinking for treating keratoconus among Jordanians","volume":"13","author":"Al","year":"2019","journal-title":"Open Ophthalmol J"},{"key":"R43-20240830","doi-asserted-by":"crossref","first-page":"4947983","DOI":"10.1155\/2018\/4947983","article-title":"Epi-off versus Epi-on corneal collagen cross-linking in keratoconus patients:A comparative study through 2-year follow-up","volume":"2018","author":"Cifariello","year":"2018","journal-title":"J Ophthalmol"},{"key":"R44-20240830","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.ophtha.2017.01.040","article-title":"Randomized controlled trial comparing transepithelial corneal cross-linking using iontophoresis with the Dresden protocol in progressive keratoconus","volume":"124","author":"Lombardo","year":"2017","journal-title":"Ophthalmology"},{"key":"R45-20240830","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":"R46-20240830","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.jcrs.2019.01.026","article-title":"Two-year outcomes of a randomized controlled trial of transepithelial corneal crosslinking with iontophoresis for keratoconus","volume":"45","author":"Lombardo","year":"2019","journal-title":"J Cataract Refract Surg"},{"key":"R47-20240830","doi-asserted-by":"crossref","first-page":"7472542","DOI":"10.1155\/2016\/7472542","article-title":"Novel technique of transepithelial corneal cross-linking using iontophoresis in progressive keratoconus","volume":"2016","author":"Lombardo","year":"2016","journal-title":"J Ophthalmol"},{"key":"R48-20240830","doi-asserted-by":"crossref","first-page":"837","DOI":"10.3928\/1081597X-20141117-02","article-title":"Evaluation of corneal changes after conventional versus accelerated corneal cross-linking:A randomized controlled trial","volume":"30","author":"Hashemian","year":"2014","journal-title":"J Refract Surg"},{"key":"R49-20240830","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.2147\/OPTH.S59840","article-title":"Accelerated versus conventional corneal collagen cross-linking in the treatment of mild keratoconus:A comparative study","volume":"8","author":"Sherif","year":"2014","journal-title":"Clin Ophthalmol"},{"key":"R50-20240830","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.ajo.2015.05.019","article-title":"Current protocols of corneal collagen cross-linking:Visual, refractive, and tomographic outcomes","volume":"160","author":"Shetty","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"R51-20240830","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jcrs.2014.07.030","article-title":"Short-term comparison of accelerated and standard methods of corneal collagen crosslinking","volume":"41","author":"Hashemi","year":"2015","journal-title":"J Cataract Refract Surg"},{"key":"R52-20240830","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.ajo.2015.08.027","article-title":"Long-term results of an accelerated corneal cross-linking protocol (18 mW\/cm2) for the treatment of progressive keratoconus","volume":"160","author":"Hashemi","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"R53-20240830","first-page":"67","article-title":"Accelerated versus conventional corneal collagen cross-linking in patients with keratoconus:An intrapatient comparative study","volume":"38","author":"Sadoughi","year":"2018","journal-title":"Int Ophthalmol"},{"key":"R54-20240830","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/ICO.0000000000001165","article-title":"Comparison of the conventional dresden protocol and accelerated protocol with higher ultraviolet intensity in corneal collagen cross-linking for keratoconus","volume":"36","author":"Choi","year":"2017","journal-title":"Cornea"},{"key":"R55-20240830","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1177\/1120672119839927","article-title":"Standard and accelerated corneal cross-linking long-term results:A randomized clinical trial","volume":"30","author":"Hashemi","year":"2020","journal-title":"Eur J Ophthalmol"},{"key":"R56-20240830","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.18240\/ijo.2020.08.07","article-title":"Comparative 2-year outcomes of conventional and accelerated corneal collagen crosslinking in progressive keratoconus","volume":"13","author":"U\u00e7akhan","year":"2020","journal-title":"Int J Ophthalmol"},{"key":"R57-20240830","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/2277-9175.200785","article-title":"Cornea collagen cross-linking for keratoconus:A comparison between accelerated and conventional methods","volume":"6","author":"Razmjoo","year":"2017","journal-title":"Adv Biomed Res"},{"key":"R58-20240830","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.ajo.2011.10.014","article-title":"Sequential topical riboflavin with or without ultraviolet a radiation with delayed intracorneal ring segment insertion for keratoconus","volume":"153","author":"Renesto","year":"2012","journal-title":"Am J Ophthalmol"},{"key":"R59-20240830","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1097\/ICO.0000000000000600","article-title":"Sequential intracorneal ring segment implantation and corneal transepithelial collagen cross-linking in keratoconus","volume":"34","author":"Elsaftawy","year":"2015","journal-title":"Cornea"},{"key":"R60-20240830","first-page":"486","article-title":"MyoRing implantation with and without corneal collagen crosslinking for the management of keratoconus","volume":"15","author":"Mohammadpour","year":"2020","journal-title":"J Ophthalmic Vis Res"},{"key":"R61-20240830","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.jcrs.2019.01.020","article-title":"Corneal crosslinking and intracorneal ring segments for keratoconus:A randomized study of concurrent versus sequential surgery","volume":"45","author":"Hersh","year":"2019","journal-title":"J Cataract Refract Surg"},{"key":"R62-20240830","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1016\/j.jcrs.2009.07.008","article-title":"Effect of treatment sequence in combined intrastromal corneal rings and corneal collagen crosslinking for keratoconus","volume":"35","author":"Coskunseven","year":"2009","journal-title":"J Cataract Refract Surg"},{"key":"R63-20240830","doi-asserted-by":"crossref","first-page":"S827","DOI":"10.3928\/1081597X-20100921-11","article-title":"Stability of simultaneous topography-guided photorefractive keratectomy and riboflavin\/UVA cross-linking for progressive keratoconus:Case reports","volume":"26","author":"Krueger","year":"2010","journal-title":"J Refract Surg"},{"key":"R64-20240830","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"},{"key":"R65-20240830","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.2147\/OPTH.S44745","article-title":"Comparison of placido disc and scheimpflug image-derived topography-guided excimer laser surface normalization combined with higher fluence CXL:The Athens protocol, in progressive keratoconus","volume":"7","author":"Kanellopoulos","year":"2013","journal-title":"Clin Ophthalmol"},{"key":"R66-20240830","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3928\/1081597X-20140120-03","article-title":"Keratoconus management:Long-term stability of topography-guided normalization combined with high-fluence CXL stabilization (the Athens protocol)","volume":"30","author":"Kanellopoulos","year":"2014","journal-title":"J Refract Surg"},{"key":"R67-20240830","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.ophtha.2016.01.010","article-title":"Long-term comparison of simultaneous topography-guided photorefractive keratectomy followed by corneal cross-linking versus corneal cross-linking alone","volume":"123","author":"Kontadakis","year":"2016","journal-title":"Ophthalmology"},{"key":"R68-20240830","doi-asserted-by":"crossref","first-page":"650","DOI":"10.3928\/1081597X-20190917-01","article-title":"Long-term comparison of combined t-PTK and CXL (Cretan protocol) versus CXL With mechanical epithelial debridement for keratoconus","volume":"35","author":"Grentzelos","year":"2019","journal-title":"J Refract Surg"},{"key":"R69-20240830","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/ICO.0000000000001791","article-title":"Randomized study of collagen cross-linking with conventional versus accelerated UVA Irradiation using riboflavin with hydroxypropyl methylcellulose:Two-year results","volume":"38","author":"Hagem","year":"2019","journal-title":"Cornea"},{"key":"R71-20240830","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.ophtha.2020.12.023","article-title":"Transepithelial versus epithelium-off corneal collagen cross-linking for corneal ectasia:A systematic review and meta-analysis","volume":"128","author":"Nath","year":"2021","journal-title":"Ophthalmology"},{"key":"R72-20240830","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1097\/j.jcrs.0000000000000686","article-title":"Endothelial cell loss after accelerated corneal crosslinking using pachymetry-guided hypo-osmolar riboflavin dosing in thin keratoconic corneas","volume":"47","author":"Yurttaser","year":"2021","journal-title":"J Cataract Refract Surg"},{"key":"R73-20240830","first-page":"94","article-title":"Ashort-term study of corneal collagen cross-linking with hypo-osmolar riboflavin solution in keratoconic corneas","volume":"8","author":"Gu","year":"2015","journal-title":"Int J Ophthalmol"},{"key":"R74-20240830","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1016\/S0886-3350(03)00343-2","article-title":"Endothelial cell damage after riboflavin-ultraviolet-A treatment in the rabbit","volume":"29","author":"Wollensak","year":"2003","journal-title":"J Cataract Refract Surg"},{"key":"R75-20240830","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.ajo.2020.12.011","article-title":"Individualized corneal cross-linking with riboflavin and UV-A in ultrathin corneas:The Sub400 protocol","volume":"224","author":"Hafezi","year":"2021","journal-title":"Am J Ophthalmol"},{"key":"R76-20240830","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1167\/iovs.13-13748","article-title":"Corneal biomechanical properties at different corneal cross-linking (CXL) irradiances","volume":"55","author":"Hammer","year":"2014","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R77-20240830","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40662-018-0116-z","article-title":"Corneal collagen crosslinking in patients treated with dextran versus isotonic hydroxypropyl methylcellulose (HPMC) riboflavin solution:A retrospective analysis","volume":"5","author":"Rapuano","year":"2018","journal-title":"Eye Vis (Lond)"},{"key":"R78-20240830","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1111\/aos.13928","article-title":"Superior outcome of corneal collagen cross-linking using riboflavin with methylcellulose than riboflavin with dextran as the main supplement","volume":"97","author":"Thorsrud","year":"2019","journal-title":"Acta Ophthalmol (Copenh)"},{"key":"R79-20240830","doi-asserted-by":"crossref","first-page":"212","DOI":"10.4103\/0974-9233.151877","article-title":"Changes in corneal topography and biomechanical properties after collagen cross linking for keratoconus:1-year results","volume":"22","author":"Sedaghat","year":"2015","journal-title":"Middle East Afr J Ophthalmol"}],"container-title":["Taiwan Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/2211-5056.361974","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:16:53Z","timestamp":1787757413000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/2211-5056.361974"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,28]]},"references-count":75,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/2211-5056.361974","relation":{},"ISSN":["2211-5056","2211-5072"],"issn-type":[{"value":"2211-5056","type":"print"},{"value":"2211-5072","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,28]]},"assertion":[{"value":"2021-11-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}