title: Intense Early Flattening After Corneal Collagen Cross-linking.
abstract: OBJECTIVE
  To report two cases of significant flattening after corneal cross-linking (CXL) for keratoconus and discuss its potential explanations and implications.
  
  
  METHODS
  Observational case report.
  
  
  RESULTS
  One year after standard CXL protocol (3 mW/cm(2) for 30 minutes and total energy of 5.4 J/cm(2)), a 28-year-old woman presented a flattening of greater than 14 diopters and a 14-year-old boy presented a flattening of 7 diopters.
  
  
  CONCLUSIONS
  Although rare, a significant flattening effect may occur during the first year after CXL, probably related to intense wound healing, increase in corneal elasticity, CXL effective depth, and central cone location. These cases suggest the necessity of a patient-specific approach and a better understanding regarding the actual mechanism behind its potent effect.
authors.forename: Marcony R
authors.initials: MR
authors.lastname: Santhiago
authors.forename: Natalia T
authors.initials: NT
authors.lastname: Giacomin
authors.forename: Carla S
authors.initials: CS
authors.lastname: Medeiros
authors.forename: David
authors.initials: D
authors.lastname: Smadja
authors.forename: Samir J
authors.initials: SJ
authors.lastname: Bechara
mesh_terms: D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D003094:Collagen / Q000378:metabolism*; D003315:Cornea / Q000473:pathology*; D003319:Corneal Stroma / Q000378:metabolism*; D019781:Corneal Topography; D003432:Cross-Linking Reagents; D004548:Elasticity / Q000502:physiology; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012256:Riboflavin / Q000627:therapeutic use; D014466:Ultraviolet Rays; D014945:Wound Healing / Q000502:physiology
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin