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Primary outcomes included the Corvis Biomechanical Factor (CBiF) and five biomechanical response parameters obtained from the Corvis ST. Tomographically, the Belin-Ambr\u00f3sio deviation index (BAD-D) and the maximal keratometry (K\n                      <jats:sub>max<\/jats:sub>\n                      ) measured by the Pentacam were analyzed. Additionally, Corvis E-staging, the thinnest corneal thickness (TCT), and the best-corrected visual acuity (BCVA) were obtained. Primary outcomes were compared using a paired t-test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The CBiF decreased significantly at the six-month (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and one-year (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) follow-ups when compared to preoperative values. E-staging behaved accordingly to the CBiF. Within the two- to four-year follow-ups, the biomechanical outcomes showed no significant differences when compared to preoperative. Tomographically, the BAD-D increased significantly during the first year after CXL with a maximum at six-months (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), while K\n                      <jats:sub>max<\/jats:sub>\n                      decreased significantly (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and continuously up to four years after CXL. The TCT was lower at all postoperative follow-up visits compared to preoperative, and the BCVA improved.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the first year after CXL, there was a temporary progression in both the biomechanical CBiF and E-staging, as well as in the tomographic analysis. CXL contributes to the stabilization of both the tomographic and biomechanical properties of the cornea up to four years postoperatively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00417-024-06549-z","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T06:01:53Z","timestamp":1718604113000},"page":"3635-3642","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Biomechanical changes following corneal crosslinking in keratoconus patients"],"prefix":"10.1007","volume":"262","author":[{"given":"Emilia","family":"Felter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin","family":"Khoramnia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Friedrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeck-Soo","family":"Son","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd U.","family":"Auffarth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6315-8484","authenticated-orcid":false,"given":"Victor A.","family":"Augustin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,17]]},"reference":[{"key":"6549_CR1","doi-asserted-by":"publisher","first-page":"101559","DOI":"10.1016\/j.clae.2021.101559","volume":"45","author":"J Santodomingo-Rubido","year":"2022","unstructured":"Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS (2022) Keratoconus: an updated review. 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Khoramnia reports grants, personal fees, and nonfinancial support from Johnson & Johnson Vision, Alcon Laboratories, Hoya Corp., Kowa Co., Ltd., Oculentis GmbH\/Teleon, Physiol S.A., Sifi Medtech Srl, and Rayner Intraocular Lenses Ltd.; grants and personal fees from Oculus Optikger\u00e4te GmbH, Carl Zeiss Meditec AG, and Ophtec BV; and grants from Acufocus Inc. outside the submitted work. G.U. Auffarth reports lecture fees and research grants from Johnson & Johnson Vision, Alcon Laboratories, Carl Zeiss Meditec AG, Hoya Corp., Kowa Co., Ltd., Oculentis GmbH\/Teleon, Physiol S.A., Rayner Intraocular Lenses Ltd., Oculus Optikger\u00e4te GmbH, Ophthec BV, Santen, Sifi Medtech Srl, Acufocus Inc., Novartis, Ursapharm and Biotech; nonfinancial support from Rheacell, Contamac, Cristalens, Croma, EyeYon, Hanita, and VSY outside the submitted work. V. A. Augustin reports research grants from Eye Yon and Kowa Co. outside the submitted work. The remaining authors have no relevant financial or non-financial interests to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}