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We developed and calibrated a patient-specific finite element model (FEM) to predict the topographic alterations resulting from CXL and applied it to three patients with keratoconus (KC) as a proof of concept.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      To calibrate the model, we performed nanoindentation and\n                      <jats:italic>ex vivo<\/jats:italic>\n                      optical coherence elastography (OCE) inflation tests before and after CXL on five human donor corneas. Nanoindentation results tuned the visco-hyperelastic parameters, while\n                      <jats:italic>ex vivo<\/jats:italic>\n                      OCE axial strains were used for validation. Personalized corneal models were generated from the topographies of the three KC patients, with regional stiffness in the affected areas adjusted based on axial strain measured by\n                      <jats:italic>in vivo<\/jats:italic>\n                      pressure-modulated OCE. Simulated CXL outcomes were then compared to 6-month clinical results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      CXL induces a 16-fold increase in the fiber-related mechanical parameters and reduces the viscoelasticity time constant by three.\n                      <jats:italic>In vivo<\/jats:italic>\n                      OCE measurements showed an average mechanical weakening of 57% in the KC regions. When compared to the clinical topography at the 6-month follow-up, the CXL-induced curvature changes predicted by the model were \u22121.5 D vs. \u22121.76 D, \u22121.65 D vs. \u22121.91 D, and \u22121.76 D vs. \u22121.57 D, for the three patients, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      By combining FEM with\n                      <jats:italic>in vivo<\/jats:italic>\n                      corneal mechanical characterization, patient-specific topographic changes can be predicted, which has the potential to improve the planning of CXL treatments.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10439-026-04236-0","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:47:52Z","timestamp":1781632072000},"page":"2786-2800","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Integration of Mechanical Testing, In Vivo Optical Coherence Elastography and Personalized Finite Element Modeling to Predict Geometrical Outcomes of Corneal Cross-Linking"],"prefix":"10.1007","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6725-3112","authenticated-orcid":false,"given":"Matteo","family":"Frigelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Lohm\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel A. 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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval for both studies described in this manuscript was obtained as detailed in the corresponding Methods sections. All procedures were conducted in accordance with the relevant institutional and national ethical standards.","order":2,"name":"Ethics","label":"Ethics Approval and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors have given their informed consent for publication of this manuscript.","order":3,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this work the authors used ChatGPT-4o in order to improve language and readability. 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