This study evaluated the clinical outcomes in keratoconus corneas following accelerated transepithelial corneal collagen cross-linking（CXL）（Avedro KXL system,Waltham,MA,USA） over one year of follow-up.The mean de...This study evaluated the clinical outcomes in keratoconus corneas following accelerated transepithelial corneal collagen cross-linking（CXL）（Avedro KXL system,Waltham,MA,USA） over one year of follow-up.The mean depth of the demarcation line measured by optical coherence tomography（OCT） was 205.19 μm.One month after surgery,a non-statistically significant change was noted in sphere（P= 0.18） and in spherical equivalent（P= 0.17）,whereas a significant improvement was observed in corrected distance visual acuity（P=0.04）.A significant change was observed in topographic astigmatism（P= 0.03） and posterior corneal a sphericity（P= 0.04）.Accelerated transepithelial CXL may be a useful technique for the management of progressive keratoconus.展开更多
AIM:To evaluate the differences in corneal biological parameters between transepithelial and epithelium-off corneal cross-linking in keratoconus.METHODS:In our prospective clinical trial,40 patients(60 eyes)with progr...AIM:To evaluate the differences in corneal biological parameters between transepithelial and epithelium-off corneal cross-linking in keratoconus.METHODS:In our prospective clinical trial,40 patients(60 eyes)with progressive keratoconus were randomized to undergo corneal cross-linking with transepithelial(TE group,n=30)or epithelium-off(EO group,n=30)keratoconus.Examinations comprised topography,corneal biomechanical analysis and specular microscopy at 6 mo postoperatively.RESULTS:The keratometer values were not significantly different between the TE and EO corneal cross-linked groups in different periods(each P>0.05).The corneal thickness of the EO group was greater than that of the TE group at 1 wk after the operation(each P<0.05).Regarding corneal biomechanical responses,the EO group showed a longer second applanation length than TE group(P=0.003).Regarding the corneal endothelial function,standard deviation of the endothelial cell size,and coefficient of variation in the cell area,the values of EO group were larger than those of TE group at 1 wk(P=0.011,0.026),and the percentage of hexagonal cells in EO group was lower than that in TE group at 1 and 6 mo(P=0.018,0.019).CONCLUSION:Epithelium-off corneal cross-linking may strengthen corneal biomechanics better than TE procedure can.However,the TE procedure with a lower ultraviolet-A irradiation intensity would be safer for corneal endothelial function.展开更多
In order to study the cross-linking density and aging constitutive relationship of HTPB coating during storage,the thermal accelerated aging tests at 0%,3%,6%and 9%prestrains were carried out.The crosslinking density ...In order to study the cross-linking density and aging constitutive relationship of HTPB coating during storage,the thermal accelerated aging tests at 0%,3%,6%and 9%prestrains were carried out.The crosslinking density of HTPB coating at different aging stages were tested using low-field^1 H NMR and the variation of cross-linking density was analyzed.The aging model of cross-linking density considering the chemical aging and the physical stretching factors was established.The uniaxial tensile tests were carried out on HTPB coating at different aging stages and the cross-linking density was introduced into Ogden hyperelastic constitutive model as a characterization parameter of correction coefficient.Combined with uniaxial tensile test results,a prestrain aging constitutive model of HTPB coating was established.The results show that the cross-linking density of HTPB coating increases rapidly at first and then slowly with the increase of thermal accelerated aging time without prestrain.Under prestrain conditions,the crosslinking density of HTPB coating decreases at the early stage,and increases rapidly at first and then slowly at the middle and late stages of thermal accelerated aging.The correlation coefficients of aging model of cross-linking density and aging constitutive model with test results are R>0.9500 and R>0.9900 respectively,which can be used to accurately describe the cross-linking density and aging constitutive relationship of HTPB coating under prestrain accelerated thermal aging conditions.展开更多
AIM：To compare the effectiveness and safety between modified cross-linking（MC）and standard cross-linking（SC）in mild or moderate progressive keratoconus.METHODS：Eligible studies were retrieved from four electroni...AIM：To compare the effectiveness and safety between modified cross-linking（MC）and standard cross-linking（SC）in mild or moderate progressive keratoconus.METHODS：Eligible studies were retrieved from four electronic databases,including CENTRAL,Clinical Trials gov,Pup Med and OVID MEDLINE.We set post-surgical maximum K value（Kmax）as the primary outcome.In addition,uncorrected and corrected distant visual acuity（UDVA and UDVA）,spherical equivalent（SE）,endothelial cell density（ECD）,central cornea thickness（CCT）and depth of demarcation line（DDL）were Meta-analyzed as secondary outcomes.Mean differences for these outcomes were pooled through either a random-effect model or fixed-effect model according to data heterogeneity.RESULTS：Twenty-four comparative studies either on accelerated cross-linking（AC）compared with SC or on transepithelial cross-linking（TC）compared with SC were included and pooled for analysis.The results indicated that MC was significantly inferior to SC at delaying Kmax deterioration[AC vs SC 0.49（95%CI：0.04-0.94,I2=75%,P=0.03）;TC vs SC 1.15（95%CI：0.54-1.75,I2=50%,P=0.0002）].SE decreased significantly for SC when compared to AC[0.62（95%CI：0.38-0.86,I2=22%,P〈0.00001）].DDL of SC was more significantly deeper than that of TC[-133.49（95%CI：-145.94 to-121.04,I2=33%,P〈0.00001）].Other outcomes demonstrated comparable results between MC and SC.CONCLUSION：SC is more favorable at halting the progression of keratoconus,but visual acuity improvement showed comparable results between MCs and SC.展开更多
Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking(CXL)techniques compared with standard epi-off CXL.Methods We searched MEDLINE and EMBASE for random...Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking(CXL)techniques compared with standard epi-off CXL.Methods We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias tool.We considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment failure.Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect size.Results A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this meta-analysis.Our analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P<0.001),and no significative differences in UDVA,Kmax,central corneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion Epi-on CXL is as effective as epi-off CXL.Except for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial parameters.Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.展开更多
Since the late 1990s corneal crosslinking(CXL)has been proposed as a new possibility to stop progression of keratoconus or secondary corneal ectasia,with the promising aim to prevent progressive visual loss due to the...Since the late 1990s corneal crosslinking(CXL)has been proposed as a new possibility to stop progression of keratoconus or secondary corneal ectasia,with the promising aim to prevent progressive visual loss due to the evolution of the pathology and to delay or avoid invasive surgical procedures such as corneal transplantation.The possibility of strengthening corneal tissue by means of a photochemical reaction of corneal collagen by the combined action of Riboflavin and ultraviolet A irradiation(UVA),radically modified the conservative management of progressive corneal ectasia.This is a review of the state of the art of CXL,reporting basic and clinical evidence.The paper describes basic principles,advantages and limits of different CXL techniques and possible future evolution of the procedure.展开更多
Background:The purpose of our study is to examine the long(5-year)efficacy of the all surface laser ablation(ASLA)combined with accelerated cross-linking(CXL)for the treatment of myopia without the use of mitomycin-C(...Background:The purpose of our study is to examine the long(5-year)efficacy of the all surface laser ablation(ASLA)combined with accelerated cross-linking(CXL)for the treatment of myopia without the use of mitomycin-C(MMC).Methods:This retrospective study consisted of 202 eyes of 118 myopic(SD:2.41,range:−1.50 to−12.75 D)patients(44 males,74 females).Mean age was 28.50 years(SD:6.45,range:18 to 51 years)that underwent ASLA with accelerated CXL for the treatment of their myopia.Results:The patients underwent routine postoperative assessment on the 1st,3rd,7th day and in the 1st,3rd,6th and 12th month,30th month(±6 months),4th and 5th year.The mean spherical equivalent(SEq)refractive error changed from−6.41±2.41 D preoperatively to−0.02±0.53 D at 5 years postoperatively.The haze score was 0.18,0.25 and 0.28 at 1,3 and 6 months postoperatively.At 12 months after the treatment,no eyes had significant corneal haze and in all the following postoperative time intervals the haze traces were gone.Conclusion:ASLA combined with accelerated CXL(ASLA-XTRA)appears to be safe,efficacious and offering very good refractive results.The potential additional benefits of this modality are the stabilizing effect of the refraction and its sterilization effect on the treated cornea without the potential side effects of MMC.展开更多
Background:The purpose of the study was to determine the advantages and disadvantages of epi-on corneal crosslinking(CXL)techniques compared with standard epi-off CXL.Methods:We searched MEDLINE and EMBASE for randomi...Background:The purpose of the study was to determine the advantages and disadvantages of epi-on corneal crosslinking(CXL)techniques compared with standard epi-off CXL.Methods:We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias tool.We considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment failure.Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect size.Results:A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this meta-analysis.Our analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P<0.001),and no significative differences in UDVA,Kmax,central corneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion:Epi-on CXL is as effective as epi-off CXL.Except for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial parameters.Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.展开更多
Background:To evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking(CXL)...Background:To evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking(CXL)to strengthen the corneal tissue and stop the progression of keratoconus.The transepithelial therapeutic ablation applied a novel concept named central corneal regularization(CCR)which could correct the corneal morphological irregularities and the eye’s spherocylindrical refractive error with minimal stromal tissue removal.Methods:Retrospective study.Eyes that underwent CCR combined with CXL were evaluated preoperatively and up to 12 months postoperatively for visual acuity,subjective refraction,corneal haze,pachymetry and maximum keratometry(Kmax).Results:Twenty four eyes of 24 patients with a mean age of 28.92±9.88 years were treated.The mean spherical equivalent(SE)refractive error changed from−0.74±1.17 D preoperatively to−1.05±1.52 D at 12 months postoperatively.The mean uncorrected distance visual acuity(UDVA)and corrected distance visual acuity(CDVA)improved.No eye lost lines of CDVA,21 had a mean improvement of 3.21 lines.The mean cylinder error and Kmax value dropped from−3.06±1.83 D and 51.38±3.29 D to−1.04±0.80 D and 48.70±2.58 D,respectively.The mean haze score at 3,6 and 12 months was 0.56,0.19 and 0.06,respectively.Conclusions:CCR combined with CXL offers promising results as a safe and effective treatment in keratoconic patients.展开更多
文摘This study evaluated the clinical outcomes in keratoconus corneas following accelerated transepithelial corneal collagen cross-linking（CXL）（Avedro KXL system,Waltham,MA,USA） over one year of follow-up.The mean depth of the demarcation line measured by optical coherence tomography（OCT） was 205.19 μm.One month after surgery,a non-statistically significant change was noted in sphere（P= 0.18） and in spherical equivalent（P= 0.17）,whereas a significant improvement was observed in corrected distance visual acuity（P=0.04）.A significant change was observed in topographic astigmatism（P= 0.03） and posterior corneal a sphericity（P= 0.04）.Accelerated transepithelial CXL may be a useful technique for the management of progressive keratoconus.
基金Supported by the National Natural Sciences Foundation of China(No.81870681)the Fundamental Research Funds of the State Key Laboratory of Ophthalmology。
文摘AIM:To evaluate the differences in corneal biological parameters between transepithelial and epithelium-off corneal cross-linking in keratoconus.METHODS:In our prospective clinical trial,40 patients(60 eyes)with progressive keratoconus were randomized to undergo corneal cross-linking with transepithelial(TE group,n=30)or epithelium-off(EO group,n=30)keratoconus.Examinations comprised topography,corneal biomechanical analysis and specular microscopy at 6 mo postoperatively.RESULTS:The keratometer values were not significantly different between the TE and EO corneal cross-linked groups in different periods(each P>0.05).The corneal thickness of the EO group was greater than that of the TE group at 1 wk after the operation(each P<0.05).Regarding corneal biomechanical responses,the EO group showed a longer second applanation length than TE group(P=0.003).Regarding the corneal endothelial function,standard deviation of the endothelial cell size,and coefficient of variation in the cell area,the values of EO group were larger than those of TE group at 1 wk(P=0.011,0.026),and the percentage of hexagonal cells in EO group was lower than that in TE group at 1 and 6 mo(P=0.018,0.019).CONCLUSION:Epithelium-off corneal cross-linking may strengthen corneal biomechanics better than TE procedure can.However,the TE procedure with a lower ultraviolet-A irradiation intensity would be safer for corneal endothelial function.
基金supported by the National Defense Pre-Research Foundation of China[grant number ZS2015070132A12002]。
文摘In order to study the cross-linking density and aging constitutive relationship of HTPB coating during storage,the thermal accelerated aging tests at 0%,3%,6%and 9%prestrains were carried out.The crosslinking density of HTPB coating at different aging stages were tested using low-field^1 H NMR and the variation of cross-linking density was analyzed.The aging model of cross-linking density considering the chemical aging and the physical stretching factors was established.The uniaxial tensile tests were carried out on HTPB coating at different aging stages and the cross-linking density was introduced into Ogden hyperelastic constitutive model as a characterization parameter of correction coefficient.Combined with uniaxial tensile test results,a prestrain aging constitutive model of HTPB coating was established.The results show that the cross-linking density of HTPB coating increases rapidly at first and then slowly with the increase of thermal accelerated aging time without prestrain.Under prestrain conditions,the crosslinking density of HTPB coating decreases at the early stage,and increases rapidly at first and then slowly at the middle and late stages of thermal accelerated aging.The correlation coefficients of aging model of cross-linking density and aging constitutive model with test results are R>0.9500 and R>0.9900 respectively,which can be used to accurately describe the cross-linking density and aging constitutive relationship of HTPB coating under prestrain accelerated thermal aging conditions.
文摘AIM：To compare the effectiveness and safety between modified cross-linking（MC）and standard cross-linking（SC）in mild or moderate progressive keratoconus.METHODS：Eligible studies were retrieved from four electronic databases,including CENTRAL,Clinical Trials gov,Pup Med and OVID MEDLINE.We set post-surgical maximum K value（Kmax）as the primary outcome.In addition,uncorrected and corrected distant visual acuity（UDVA and UDVA）,spherical equivalent（SE）,endothelial cell density（ECD）,central cornea thickness（CCT）and depth of demarcation line（DDL）were Meta-analyzed as secondary outcomes.Mean differences for these outcomes were pooled through either a random-effect model or fixed-effect model according to data heterogeneity.RESULTS：Twenty-four comparative studies either on accelerated cross-linking（AC）compared with SC or on transepithelial cross-linking（TC）compared with SC were included and pooled for analysis.The results indicated that MC was significantly inferior to SC at delaying Kmax deterioration[AC vs SC 0.49（95%CI：0.04-0.94,I2=75%,P=0.03）;TC vs SC 1.15（95%CI：0.54-1.75,I2=50%,P=0.0002）].SE decreased significantly for SC when compared to AC[0.62（95%CI：0.38-0.86,I2=22%,P〈0.00001）].DDL of SC was more significantly deeper than that of TC[-133.49（95%CI：-145.94 to-121.04,I2=33%,P〈0.00001）].Other outcomes demonstrated comparable results between MC and SC.CONCLUSION：SC is more favorable at halting the progression of keratoconus,but visual acuity improvement showed comparable results between MCs and SC.
基金This study has been financed in part by the Network for Cooperative Research in Health“OFTARED”—Reference:RD16/0008/0012.Funded by Instituto de Salud Carlos III and co-funded by the European Regional Development Fund(ERDF),Project“A way to make Europe”.
文摘Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking(CXL)techniques compared with standard epi-off CXL.Methods We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias tool.We considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment failure.Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect size.Results A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this meta-analysis.Our analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P<0.001),and no significative differences in UDVA,Kmax,central corneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion Epi-on CXL is as effective as epi-off CXL.Except for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial parameters.Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.
文摘Since the late 1990s corneal crosslinking(CXL)has been proposed as a new possibility to stop progression of keratoconus or secondary corneal ectasia,with the promising aim to prevent progressive visual loss due to the evolution of the pathology and to delay or avoid invasive surgical procedures such as corneal transplantation.The possibility of strengthening corneal tissue by means of a photochemical reaction of corneal collagen by the combined action of Riboflavin and ultraviolet A irradiation(UVA),radically modified the conservative management of progressive corneal ectasia.This is a review of the state of the art of CXL,reporting basic and clinical evidence.The paper describes basic principles,advantages and limits of different CXL techniques and possible future evolution of the procedure.
文摘Background:The purpose of our study is to examine the long(5-year)efficacy of the all surface laser ablation(ASLA)combined with accelerated cross-linking(CXL)for the treatment of myopia without the use of mitomycin-C(MMC).Methods:This retrospective study consisted of 202 eyes of 118 myopic(SD:2.41,range:−1.50 to−12.75 D)patients(44 males,74 females).Mean age was 28.50 years(SD:6.45,range:18 to 51 years)that underwent ASLA with accelerated CXL for the treatment of their myopia.Results:The patients underwent routine postoperative assessment on the 1st,3rd,7th day and in the 1st,3rd,6th and 12th month,30th month(±6 months),4th and 5th year.The mean spherical equivalent(SEq)refractive error changed from−6.41±2.41 D preoperatively to−0.02±0.53 D at 5 years postoperatively.The haze score was 0.18,0.25 and 0.28 at 1,3 and 6 months postoperatively.At 12 months after the treatment,no eyes had significant corneal haze and in all the following postoperative time intervals the haze traces were gone.Conclusion:ASLA combined with accelerated CXL(ASLA-XTRA)appears to be safe,efficacious and offering very good refractive results.The potential additional benefits of this modality are the stabilizing effect of the refraction and its sterilization effect on the treated cornea without the potential side effects of MMC.
基金financed in part by the Network for Cooperative Research in Health“OFTARED”—Reference:RD16/0008/0012Funded by Instituto de Salud Carlos IIIco-funded by the European Regional Development Fund(ERDF),Project"A way to make Europe".
文摘Background:The purpose of the study was to determine the advantages and disadvantages of epi-on corneal crosslinking(CXL)techniques compared with standard epi-off CXL.Methods:We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias tool.We considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment failure.Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect size.Results:A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this meta-analysis.Our analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P<0.001),and no significative differences in UDVA,Kmax,central corneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion:Epi-on CXL is as effective as epi-off CXL.Except for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial parameters.Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.
文摘Background:To evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking(CXL)to strengthen the corneal tissue and stop the progression of keratoconus.The transepithelial therapeutic ablation applied a novel concept named central corneal regularization(CCR)which could correct the corneal morphological irregularities and the eye’s spherocylindrical refractive error with minimal stromal tissue removal.Methods:Retrospective study.Eyes that underwent CCR combined with CXL were evaluated preoperatively and up to 12 months postoperatively for visual acuity,subjective refraction,corneal haze,pachymetry and maximum keratometry(Kmax).Results:Twenty four eyes of 24 patients with a mean age of 28.92±9.88 years were treated.The mean spherical equivalent(SE)refractive error changed from−0.74±1.17 D preoperatively to−1.05±1.52 D at 12 months postoperatively.The mean uncorrected distance visual acuity(UDVA)and corrected distance visual acuity(CDVA)improved.No eye lost lines of CDVA,21 had a mean improvement of 3.21 lines.The mean cylinder error and Kmax value dropped from−3.06±1.83 D and 51.38±3.29 D to−1.04±0.80 D and 48.70±2.58 D,respectively.The mean haze score at 3,6 and 12 months was 0.56,0.19 and 0.06,respectively.Conclusions:CCR combined with CXL offers promising results as a safe and effective treatment in keratoconic patients.
