UNASSIGNED: Photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) stabilizes the corneal stroma and eliminates microorganisms. Numerous PACK-CXL protocols, using different energy sources and chromophores, have been applied in preclinical studies, including live animal studies, with various experimental designs and endpoints. So far, a systematic mapping of the applied protocols and consistency across studies seems lacking but is essential to guide future research.
UNASSIGNED: The scoping review protocol was in line with the JBI Manual for Evidence Synthesis. Electronic databases were searched (Embase, MEDLINE, Scopus, Web of Science) to identify eligible records, followed by a two-step selection process (title and abstract screening, full text screening) for record inclusion. We extracted information on (1) different PACK-CXL protocol characteristics; (2) infectious pathogens tested; (3) study designs and experimental settings; and (4) endpoints used to determine antimicrobial and tissue stabilizing effects. The information was charted in frequency maps.
UNASSIGNED: The searches yielded 3654 unique records, 233 of which met the inclusion criteria. With 103 heterogeneous endpoints, the researchers investigated a wide range of PACK-CXL protocols. The tested microorganisms reflected pathogens commonly associated with infectious keratitis. Bacterial solutions and infectious keratitis rabbit models were the most widely used models to study the antimicrobial effects of PACK-CXL.
UNASSIGNED: If preclinical PACK-CXL studies are to guide future translational research, further cross-disciplinary efforts are needed to establish, promote, and facilitate acceptance of common endpoints relevant to PACK-CXL.
UNASSIGNED: Systematic mapping of PACK-CXL protocols in preclinical studies guides future translational research.

In recent years, the synergistic crosslinked networks formed by zinc oxide (ZnO) particles and organic polymers have gained significant attention. This importance is ascribed due to the valuable combination of low band gap containing ZnO particles with responsive behavior containing organic polymers. These properties of both ZnO and organic polymers make a suitable system of crosslinked ZnO-organic polymer composite (CZOPC) for various applications in the fields of biomedicine, catalysis, and environmental perspectives. The literature extensively provided the diverse morphologies and structures of CZOPC, and these architectural structures play a crucial role in determining their efficiency across various applications. Consequently, the careful design of CZOPC shapes tailored to specific purposes has become a focal point. This comprehensive review provides insights into the classifications, synthetic approaches, characterizations, and applications of ZnO particles decorated in organic polymers with crosslinked network. The exploration extends to the adsorption, environmental, catalytic, and biomedical applications of ZnO-organic polymer composites. Adopting a tutorial approach, the review systematically investigates and elucidates the applications of CZOPC with a comprehensive understanding of their diverse capabilities and uses.

OBJECTIVE: To report the first case of Rhizopus sp keratitis in a 15-year-old male patient who had undergone a conventional Epi-off CXL procedure for progressive keratoconus.
METHODS: A 15-year-old male studying at school presented with defective vision in both eyes recently. He was diagnosed with progressive keratoconus in the right eye more than left eye. After the conventional CXL procedure, the patient developed corneal ulcer on third postoperative day.
RESULTS: The microbiological diagnosis of both BCL and ulcer revealed Rhizopus sp. The patient responded to topical antifungals, and the ulcer entirely healed with a large central scar.
CONCLUSIONS: Rhizopus keratitis is rare in a healthy individual. Ours is the first case report of Rhizopus keratitis in patient undergone CXL.

UNASSIGNED: New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way.
UNASSIGNED: This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies.
UNASSIGNED: A multidimensional comprehensive systematic narrative review.
UNASSIGNED: A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed.
UNASSIGNED: Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes.
UNASSIGNED: The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients.
UNASSIGNED: The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.
Keratoconus: from fundamentals to future Artificial intelligence has changed how we treat the eye disease keratoconus in recent years. This study examines the many keratoconus therapies available, including surgery and contact lens wear, and how artificial intelligence can improve the safety and accuracy of these procedures. We combed through numerous papers to locate this data. To achieve the best outcomes, several parameters and methods should be evaluated. According to the study, some elements from eye scans are more useful than others. The idea behind using artificial intelligence is to help patients see better and treat keratoconus more effectively.

Corneal crosslinking (CXL) is used for treating keratoconus and post-laser in situ keratomileusis ectasia. However, refractive surgery is not usually performed with prophylactic CXL. Therefore, we performed a meta-analysis comparing outcomes of refractive surgeries with vs without prophylactic CXL. We systematically searched databases for studies comparing refractive surgeries for myopic correction with vs without prophylactic corneal crosslinking. Review Manager 5.4.1 was used to perform statistical analysis. We included 2820 eyes from 28 studies. Compared with refractive surgery alone, surgery with prophylactic CXL resulted in decreased central corneal thickness, corrected distance visual acuity logMAR, and safety and efficacy indices. There were no significant differences in postoperative uncorrected distance visual acuity of 20/20 or better at ≥12 months and other visual outcomes among both groups. More randomized controlled trials with standard crosslinking protocols are needed to analyze the prophylactic use of crosslinking with refractive surgeries.

The history of corneal cross-linking (CXL) dates back to 2003 when some German scientists investigated possible treatments to harden the corneal structure to increase its resistance in ectatic corneal diseases. Nowadays, CXL is considered the most effective therapy in ectatic corneal diseases due to its proven efficacy in hardening the cornea, thus halting the development of the disease. Since 2003, CXL applications have dramatically expanded and have been implemented in several other areas such as infectious keratitis, corneal edema, and before performing keratoplasty for various purposes. Moreover, several irradiation patterns are being studied to correct refractive errors, taking into account the corneal refractive changes that occur after the procedure. Currently, scleral cross-linking is also being investigated as a potential therapy in cases of progressive myopia and glaucoma. In this article, we provide a comprehensive overview of the available applications of cross-linking in nonectatic ocular conditions and highlight the possible future indications of this procedure.

OBJECTIVE: Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to compare the efficacy and safety of epithelium-on versus epithelium-off CXL to treat keratoconus.
METHODS: We searched PubMed, Medline, Embase, Web of Science, and Scopus databases. We included studies that compared standard epithelium-off with epithelium-on CXL. The primary outcome measures were changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax), and the secondary outcomes were uncorrected distance visual acuity (UDVA), central corneal thickness (CCT), and adverse events. A meta-analysis was performed on the primary and secondary outcomes based on the weighted mean differences between baseline to 12-month follow-up.
RESULTS: The search retrieved 887 publications with 27 included in the systematic review. A total of 1622 eyes (1399 patients; age 25.51 ± 4.02 years) were included in comparisons of epithelium-off to epithelium-on CXL in keratoconus. Epithelium-off CXL treated 800 eyes and epithelium-on CXL for 822 eyes. At 12-month follow-up, CDVA and Kmax showed no significant difference between the epithelium-off and epithelium-on CXL. The secondary outcomes showed that UDVA was better in epithelium-off CXL (- 0.11D, 95% CI - 0.12, - 0.1; p < 0.001) and there was more thinning in CCT in epithelium-off CXL (- 3.23 μm, 95% CI - 4.64, - 1.81; p <0.001).
CONCLUSIONS: Epithelium-off and epithelium-on CXL were both effective to treat progressive keratoconus. Further research is needed to compare the long-term outcomes and safety of both CXL protocols for adaptation into clinical practice.

Induced corneal collagen crosslinking and mechanical stiffening via ultraviolet-A photoactivation of riboflavin (UVA CXL) is now a common treatment for corneal ectasia and Keratoconus. Some effects of the procedure such as induced mechanical stiffening, corneal flattening, and cellular toxicity are well-known, but others remain more controversial. Authors report a variety of contradictory effects, and provide evidence based on individual results and observations. A full understanding of the effects of and mechanisms behind this procedure are essential to predicting its outcome. A growing interest in modifications to the standard UVA CXL protocol, such as transepithelial or accelerated UVA CXL, makes analyzing the literature as a whole more urgent. This review presents an analysis of both the agreed-upon and contradictory results reported and the various methods used to obtain them.

This review emphasizes the crucial role of enzyme immobilization technology in advancing the production of two main biofuels, ethanol and biodiesel, with a specific focus on the Cross-linked Enzyme Aggregates (CLEAs) strategy. This method of immobilization has gained attention due to its simplicity and affordability, as it does not initially require a solid support. CLEAs synthesis protocol includes two steps: enzyme precipitation and cross-linking of aggregates using bifunctional agents. We conducted a thorough search for papers detailing the synthesis of CLEAs utilizing amylases, cellulases, and hemicellulases. These key enzymes are involved in breaking down starch or lignocellulosic materials to produce ethanol, both in first and second-generation processes. CLEAs of lipases were included as these enzymes play a crucial role in the enzymatic process of biodiesel production. However, when dealing with large or diverse substrates such as lignocellulosic materials for ethanol production and oils/fats for biodiesel production, the use of individual enzymes may not be the most efficient method. Instead, a system that utilizes a blend of enzymes may prove to be more effective. To innovate in the production of biofuels (ethanol and biodiesel), enzyme co-immobilization using different enzyme species to produce Combi-CLEAs is a promising trend.

OBJECTIVE: To compare the efficacy of phakic intra-ocular lenses in isolation or in combination with corneal crosslinking (CXL) and/or intra-stromal corneal ring segments (ICRS) in keratoconus.
METHODS: Data extracted from the publications meeting the selection. The outcome parameters included mean pre- and post-operative uncorrected distance visual acuity, corrected distance visual acuity (CDVA), sphere and cylinder of refraction and complications. Available data analyzed with Cochrane Review Manager.
RESULTS: A total of 23 studies including 464 eyes were included. All the parameters showed significant improvement in all subgroups other than CDVA in ACPIOL + CXL subgroup and cylinder in PIOL + CXL subgroups. There was not a significant difference between PCPIOL and ACPIOL in the outcomes, exception was more improvement of CDVA in \"ACPIOL only\" than\" PCPIOL only\" subgroup.
CONCLUSIONS: Both PCPIOLs and ACPIOLs are comparably safe and efficient options in management of KCN and their efficacy significantly improves when combined with CXL/ICRS.