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The following parameters were assessed preoperatively and 6\u00a0months postoperatively: biomechanically corrected intraocular pressure (bIOP), maximum and mean keratometry (K\n                      <jats:sub>max<\/jats:sub>\n                      and K\n                      <jats:sub>m<\/jats:sub>\n                      ), minimum and central corneal thickness (MCT and CCT), corneal coma, best-corrected visual acuity (BCVA), deformation amplitude ratio at 2\u00a0mm nasal\/temporal (DAR2), integrated inverse radius (IIR), stiffness parameter at first applanation (SP-A1), highest concavity time (HCT) and two versions of stress\u2013strain index (SSIv1 and SSIv2).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 75 eyes from 72 patients were included (31 in the transEpi ACXL group and 44 in the transPTK ACXL group). The two groups were comparable in age (23.0\u2009\u00b1\u20095.0 vs. 21.3\u2009\u00b1\u20095.2\u00a0years) and TKC grade distribution (grades 1\u20134), with no statistically significant between-group differences (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.321 and 0.766, respectively). Both groups exhibited significant reductions in IIR, and increases in SSIv1 and SSIv2 (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). The improvements in K\n                      <jats:sub>max<\/jats:sub>\n                      , coma, and SSIv2 were greater in the transPTK ACXL group than in the transEpi ACXL group (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). The relative difference in SSIv2 (SSIv2\n                      <jats:sub>Rdif<\/jats:sub>\n                      ) exceeded those of other biomechanical parameters in both groups (transEpi ACXL: SSIv2\n                      <jats:sub>Rdif<\/jats:sub>\n                      \u2009&gt;\u2009DAR2\n                      <jats:sub>Rdif<\/jats:sub>\n                      , IIR\n                      <jats:sub>dif<\/jats:sub>\n                      ; transPTK ACXL: SSIv2\n                      <jats:sub>Rdif<\/jats:sub>\n                      \u2009&gt;\u2009DAR2\n                      <jats:sub>Rdif<\/jats:sub>\n                      , IIR\n                      <jats:sub>Rdif<\/jats:sub>\n                      , SP-A1\n                      <jats:sub>Rdif<\/jats:sub>\n                      , HCT\n                      <jats:sub>Rdif<\/jats:sub>\n                      , and SSIv1\n                      <jats:sub>Rdif<\/jats:sub>\n                      , all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TransPTK ACXL resulted in better biomechanical and visual benefits in comparison with transEpi ACXL 6\u00a0months after treatment. SSIv2 demonstrated superior performance in assessing the efficacy of corneal cross-linking.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40662-026-00482-4","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T01:30:12Z","timestamp":1775007012000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Variation in corneal biomechanical properties following continuous cross-linking treatment"],"prefix":"10.1186","volume":"13","author":[{"given":"ChenHao","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XinYu","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YeWei","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HongJiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JiaHui","family":"Zong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XuanYa","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2954-0548","authenticated-orcid":false,"given":"Daniela","family":"Oehring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XiaoFei","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YanJie","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YuFeng","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ShiHao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2800-6612","authenticated-orcid":false,"given":"Jia","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0629-0734","authenticated-orcid":false,"given":"QinMei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elsheikh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9881-6267","authenticated-orcid":false,"given":"FangJun","family":"Bao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"issue":"5. 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Jia Qu is the editor in chief of this journal. All other authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13"}}