Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers

Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers Publisher Pubmed

Mohammadi A ; Dehghani S ; Abbas H ; Savage D ; Ashrafi E ; Hafezi F ; Latifi G ; Beheshtnejad A H ; Alipour F

Source: Journal of Cataract and Refractive Surgery Published:2026

Abstract

Purpose: – To evaluate the impact of high oxygen concentration using a novel oxygen chamber on epi-off corneal cross-linking (CXL) efficacy and patients’ perceived pain during the procedure. Setting: – Farabi Eye Hospital, Tehran, Iran. Design: – Interventional randomized clinical trial. Methods: – Forty-eight eyes with progressive keratoconus were enrolled. The high-oxygen group (24 eyes) underwent accelerated epi-off CXL (9 mW/cm2 UV-A, 5.4 J/cm2 for 10 minutes) in a controlled high-oxygen environment (∼60%) using a novel oxygen chamber, while the control group (24 eyes) underwent the same protocol under ambient air oxygen (∼21%). Visual acuity, manifest refraction, and keratometry values were measured at baseline, 1 month, and 12 months post-CXL. Demarcation line depth and endothelial cell density were recorded at 1 month postoperatively. Pain was assessed intraoperatively using the Wong-Baker FACES scale (WBF). Results: – The high-oxygen group demonstrated significantly deeper demarcation line depth (307 ± 14 µm vs 279 ± 23 µm, p<0.001) and greater reductions in keratometry values (K1 and K2) at 12 months (p=0.04 and p=0.02, respectively). Compared to baseline, significant improvements in K1 (p=0.02), K2 (p=0.02), and Kmax (p<0.01) were observed in the high-oxygen group, whereas only K1 showed a significant improvement in the ambient oxygen group (p=0.02). Endothelial cell count remained stable in both groups. Patient reported intraoperative pain scores were significantly lower in the high-oxygen group (Wong-Baker FACES scale (2.4 ± 0.9 vs 3.4 ± 0.7, p=0.003). Conclusion: – Use of the oxygen chamber to create a high-oxygen environment during accelerated epi-off CXL was associated with deeper stromal demarcation and improved keratometric outcomes, while also reducing intraoperative pain. This approach may improve clinical outcomes and patient experience during CXL. Copyright © 2026 Published by Wolters Kluwer on behalf of ASCRS and ESCRS

Style	Citing Format
MLA	Mohammadi A, et al.. "Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers." Journal of Cataract and Refractive Surgery, vol. , no. , 2026, pp. -.
APA	Mohammadi A, Dehghani S, Abbas H, Savage D, Ashrafi E, Hafezi F, Latifi G, Beheshtnejad A H, Alipour F (2026). Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers. Journal of Cataract and Refractive Surgery, (), -.
Chicago	Mohammadi A, Dehghani S, Abbas H, Savage D, Ashrafi E, Hafezi F, Latifi G, Beheshtnejad A H, Alipour F. "Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers." Journal of Cataract and Refractive Surgery , no. (2026): -.
Harvard	Mohammadi A et al. (2026) 'Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers', Journal of Cataract and Refractive Surgery, (), pp. -.
Vancouver	Mohammadi A, Dehghani S, Abbas H, Savage D, Ashrafi E, Hafezi F, et al.. Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers. Journal of Cataract and Refractive Surgery. 2026;():-.
BibTex	@article{ author = {Mohammadi A and Dehghani S and Abbas H and Savage D and Ashrafi E and Hafezi F and Latifi G and Beheshtnejad A H and Alipour F}, title = {Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers}, journal = {Journal of Cataract and Refractive Surgery}, volume = {}, number = {}, pages = {-}, year = {2026} }
RIS	TY - JOUR AU - Mohammadi A AU - Dehghani S AU - Abbas H AU - Savage D AU - Ashrafi E AU - Hafezi F AU - Latifi G AU - Beheshtnejad A H AU - Alipour F TI - Enhancing Patient Comfort in Epi-Off Crosslinking: The Potential of High-O2 Chambers JO - Journal of Cataract and Refractive Surgery VL - IS - SP - EP - PY - 2026 ER -

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