ArticleTranslational vision science & technology2023
How Modifications of Corneal Cross-Linking Protocols Influence Corneal Resistance to Enzymatic Digestion and Treatment Depth.
Article in Translational vision science & technology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 8 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 14 citations in OpenAlex.
- The Critical Role of Oxygen Supplementation in Epithelium-On Corneal Cross-Linking: A Narrative Review.Advances in therapy · 2026Review
- Bridging gaps in corneal ulcer management: Can photoactivated chromophore for infectious keratitis-corneal collagen cross-linking delay or replace therapeutic keratoplasty?World journal of transplantation · 2026Article
- Antibiotic nanozyme hydrogel depot for single-injection MDR bacterial keratitis therapyMaterials today. Bio · 2026Article
- Corneal enzymatic digestion resistance in the presence of oestradiol and oestradiol plus selective tissue oestrogenic activity regulators (STEAR).BMJ open ophthalmology · 2025Article
- Corneal Resistance to Enzymatic Digestion After Rose Bengal and Combined Rose Bengal/Riboflavin Cross-Linking Is Oxygen Independent.Translational vision science & technology · 2025Article
- Evaluation of photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) in feline infectious keratitis-patient demographics, treatment protocols, risk factors, and treatment outcome: a retrospective study.Veterinary ophthalmology · 2025Article
- Effect of accelerated high-fluence riboflavin and rose bengal-mediated corneal cross-linking on resistance to enzymatic digestion.BMC ophthalmology · 2024Article
- Corneal collagen cross-linking in patients with keratoconus from the Dresden protocol to customized solutions: theoretical basis.International journal of ophthalmology · 2024Review
Corrections and comments
- Erratum issued
Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Purpose: The purpose of this study was to determine the effects of the Photoactivated Chromophore for Keratitis Corneal Cross-Linking (PACK-CXL) protocol modifications on corneal resistance to enzymatic digestion and treatment depth. Methods: Eight hundred one ex vivo porcine eyes were randomly divided into groups of 12 to 86 corneas, treated with various epi-off PACK-CXL modifications, including acceleration (30 > 2 minutes, 5.4 J/cm2), increased fluence (5.4 > 32.4 J/cm2), deuterium oxide (D2O) supplementation, different carrier types (dextran versus hydroxypropyl methylcellulose [HPMC]), increased riboflavin concentration (0.1 > 0.4%), and riboflavin replenishment during irradiation (yes/no). Control group eyes did not receive PACK-CXL. A pepsin digestion assay was used to determine corneal resistance to enzymatic digestion. A phalloidin fluorescent imaging assay was used to determine the PACK-CXL treatment effect depth. Differences between groups were evaluated using a linear model and a derivative method, respectively. Results: PACK-CXL significantly increased corneal resistance to enzymatic digestion compared to no treatment (P < 0.03). When compared to a 10 minute, 5.4 J/cm2 PACK-CXL protocol, fluences of 16.2 J/cm2 and higher increased corneal resistance to enzymatic digestion by 1.5- to 2-fold (P < 0.001). Other protocol modifications did not significantly change corneal resistance. A 16.2 J/cm2 fluence also increased collagen compaction in the anterior stroma, whereas omitting riboflavin replenishment during irradiation increased PACK-CXL treatment depth. Conclusions: Increasing fluence will likely optimize PACK-CXL treatment effectiveness. Treatment acceleration reduces treatment duration without compromising effectiveness. Translational Relevance: The generated data help to optimize clinical PACK-CXL settings and direct future research efforts.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.