Tomographic assessment of the thinnest corneal point following customized epithelium-off cross-linking for progressive ectasia
Medical hypothesis, discovery & innovation in optometry,
Vol. 7 No. 2 (2026),
24 July 2026
,
Page 58-66
https://doi.org/10.51329/mehdioptometry246
Abstract
Background: Customized corneal cross-linking (CXL) enables spatially individualized ultraviolet-A (UVA) irradiation of ectatic corneas. However, changes in the thickness and spatial location of the thinnest corneal point remain insufficiently characterized. This study evaluated 1-year changes in these parameters following customized epithelium-off CXL for progressive corneal ectasia. Secondary aims were to assess keratometric, visual, refractive, and corneal aberrometric outcomes and correlations of age with baseline, 1-year postoperative, and longitudinal changes in thinnest-point location and pachymetry.Methods: This retrospective interventional case series consecutively included patients with progressive corneal ectasia who underwent customized epithelium-off CXL and completed 1-year follow-up. Treatment was performed using the Mosaic platform with individualized spatial irradiation patterns planned from preoperative tomographic maps. The treatment pattern was geometrically centred on the pupil, with a patient-specific offset derived from the x- and y-coordinates of the thinnest corneal point to target the ectatic region using spatially graded UVA irradiation. Corneal pachymetry and thinnest-point x- and y-coordinates were measured with the Sirius 3D Corneal Topographer at baseline and 1 year. Secondary outcomes included maximum keratometry (Kmax), mean keratometry (Kmean), corrected and uncorrected distance visual acuity (CDVA and UDVA), refractive astigmatism, and total coma.
Results: The study included 32 eyes of 23 patients: 12 men (52.2%) and 11 women (47.8%), with a mean (standard deviation [SD]) age of 24.39 (4.13) years (range, 19–34). Twenty-eight eyes (87.5%) had keratoconus and 4 (12.5%) had post-LASIK ectasia. Mean (SD) thinnest corneal thickness decreased significantly from 442.28 (31.09) micrometre preoperatively to 405.75 (29.71) micrometre at 1 year (P < 0.001), with no significant changes in the x- or y-coordinates of the thinnest corneal point (both P > 0.05). Significant reductions occurred in Kmax, Kmean, CDVA, and total coma (all P < 0.05), whereas UDVA and refractive astigmatism did not change significantly (both P > 0.05). Age was not significantly correlated with preoperative or 1-year x- or y-coordinates or with preoperative or postoperative thinnest corneal thickness (all P > 0.05). A moderate positive correlation with change in the y-coordinate (r = + 0.444; P < 0.05) was not retained after adjustment for within-subject inter-eye correlation using a mixed-effects model (P > 0.05).
Conclusions: Customized epithelium-off CXL was associated with significant 1-year reductions in thinnest corneal thickness and corneal steepness, improvements in selected visual and aberrometric outcomes, and stable thinnest-point location. Larger prospective controlled studies with longer follow-up are needed to determine the durability and clinical significance of these structural changes.
Keywords:
- keratoconus
- ectasia
- LASIK
- laser intrastromal keratomileusis
- corneal collagen cross-linking
- epithelium-off corneal cross-linking
- epi off CXL
- corneal topographies
- visual acuities
- corneal thickness measurement
References
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2. Maharana PK, Dubey A, Jhanji V, Sharma N, Das S, Vajpayee RB. Management of advanced corneal ectasias. Br J Ophthalmol. 2016 Jan;100(1):34-40. doi: 10.1136/bjophthalmol-2015-307059. Epub 2015 Aug 20. PMID: 26294106.
3. Asimellis G, Kaufman EJ. Keratoconus. 2024 Apr 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. PMID: 29262160.
4. Wolle MA, Randleman JB, Woodward MA. Complications of Refractive Surgery: Ectasia After Refractive Surgery. Int Ophthalmol Clin. 2016 Spring;56(2):127-39. doi: 10.1097/IIO.0000000000000102. PMID: 26938343; PMCID: PMC4780337.
5. Sinha Roy A, Dupps WJ Jr. Patient-specific computational modeling of keratoconus progression and differential responses to collagen cross-linking. Invest Ophthalmol Vis Sci. 2011 Nov 25;52(12):9174-87. doi: 10.1167/iovs.11-7395. PMID: 22039252; PMCID: PMC3253542.
6. Wang C, Lou Y, Ye Y, Shen S, Bao F, Wang J, Elsheikh A. Evaluating corneal cross-linking using Stress-Strain Index maps: a finite element study. J R Soc Interface. 2025 Aug;22(229):20250234. doi: 10.1098/rsif.2025.0234. Epub 2025 Aug 27. PMID: 40858243; PMCID: PMC12380491.
7. Frigelli M, Ariza Gracia MA, Aydemir ME, Torres-Netto EA, Hafezi F, Rozema J, Büchler P, Kling S. Predicting the Effects of Customized Corneal Cross-Linking on Corneal Geometry. Invest Ophthalmol Vis Sci. 2025 Sep 2;66(12):51. doi: 10.1167/iovs.66.12.51. PMID: 40985801; PMCID: PMC12468094.
8. Hsu JH, Tsai TH, Lin TW. Clinical Outcomes and Safety of Customized Corneal Cross-linking for Keratoconus: A Systematic Review and Meta-analysis. J Refract Surg. 2026 May;42(5):e496-e507. doi: 10.3928/1081597X-20260216-01. Epub 2026 May 1. PMID: 42113928.
9. Nordström M, Schiller M, Fredriksson A, Behndig A. Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results. Br J Ophthalmol. 2017 Jul;101(7):920-925. doi: 10.1136/bjophthalmol-2016-309210. Epub 2016 Nov 29. PMID: 27899371.
10. Godefrooij DA, Gans R, Imhof SM, Wisse RP. Nationwide reduction in the number of corneal transplantations for keratoconus following the implementation of cross-linking. Acta Ophthalmol. 2016 Nov;94(7):675-678. doi: 10.1111/aos.13095. Epub 2016 May 23. PMID: 27213687.
11. Jadidi K, Mosavi SA, Nejat F, Mohammadi N, Aghamolaei H, Daryabari SH, Torabi H, Alishiri A. Use of low-vault posterior chamber collagen copolymer phakic intraocular lenses for the correction of myopia: a 3-year follow-up. Graefes Arch Clin Exp Ophthalmol. 2019 Jul;257(7):1555-1560. doi: 10.1007/s00417-019-04336-9. Epub 2019 May 27. PMID: 31131424.
12. Alkhabbaz AA, Karam MH, Pollmann AS, Nath S, Lau THA, Al-Awadhi H, Abbas K, Jabbour S. Safety and Efficacy of Posterior Chamber Phakic Implantable Collamer Lenses in Patients with Keratoconus: A Systematic Review and Meta-Analysis. Am J Ophthalmol. 2025 Mar;271:222-232. doi: 10.1016/j.ajo.2024.11.013. Epub 2024 Nov 28. PMID: 39613132.
13. Jin Y, McAlinden C, Sun Y, Wen D, Wang Y, Yu J, Feng K, Song B, Wang Q, Chen S, Huang J. Sirius Scheimpflug-Placido versus ultrasound pachymetry for central corneal thickness: meta-analysis. Eye Vis (Lond). 2021 Feb 18;8(1):5. doi: 10.1186/s40662-021-00227-5. PMID: 33602345; PMCID: PMC7891160.
14. Ruiz-Belda C, Piñero DP, Ruiz-Fortes P, Soto-Negro R, Moya M, Pérez-Cambrodí RJ, Artola A. Intra-session repeatability of iridocorneal angle measurements provided by a Scheimpflug photography-based system in healthy eyes. Graefes Arch Clin Exp Ophthalmol. 2016 Jan;254(1):169-75. doi: 10.1007/s00417-015-3105-0. Epub 2015 Jul 15. PMID: 26174969.
15. Sahu J. Corneal topography: sirius. Delhi Journal Of Ophthalmology. 2021 Oct 1;32(2):119-24. doi: 10.7869/djo.731.
16. Gomes JA, Tan D, Rapuano CJ, Belin MW, Ambrósio R Jr, Guell JL, Malecaze F, Nishida K, Sangwan VS; Group of Panelists for the Global Delphi Panel of Keratoconus and Ectatic Diseases. Global consensus on keratoconus and ectatic diseases. Cornea. 2015 Apr;34(4):359-69. doi: 10.1097/ICO.0000000000000408. PMID: 25738235.
17. Tsai PS, Dowidar A, Naseri A, McLeod SD. Predicting time to refractive stability after discontinuation of rigid contact lens wear before refractive surgery. J Cataract Refract Surg. 2004 Nov;30(11):2290-4. doi: 10.1016/j.jcrs.2004.05.021. PMID: 15519077.
18. McAlinden C, Lockington D. Cessation of contact lenses prior to corneal tomography for keratoconus monitoring: results from a clinician survey. Eye (Lond). 2024 Dec;38(18):3603-3604. doi: 10.1038/s41433-024-03352-2. Epub 2024 Oct 11. PMID: 39394369; PMCID: PMC11621536.
19. Goudie C, Tatham A, Davies R, Sifton A, Wright M. The effect of the timing of the cessation of contact lens use on the results of biometry. Eye (Lond). 2018 Jun;32(6):1048-1054. doi: 10.1038/s41433-018-0019-1. Epub 2018 Feb 2. PMID: 29391575; PMCID: PMC5997671.
20. Kanclerz P, Khoramnia R, Wang X. Current Developments in Corneal Topography and Tomography. Diagnostics (Basel). 2021 Aug 13;11(8):1466. doi: 10.3390/diagnostics11081466. PMID: 34441401; PMCID: PMC8392046.
21. Nasser CK, Singer R, Barkana Y, Zadok D, Avni I, Goldich Y. Repeatability of the Sirius imaging system and agreement with the Pentacam HR. J Refract Surg. 2012 Jul;28(7):493-7. doi: 10.3928/1081597X-20120619-01. PMID: 22767167.
22. Cassagne M, Pierné K, Galiacy SD, Asfaux-Marfaing MP, Fournié P, Malecaze F. Customized Topography-Guided Corneal Collagen Cross-linking for Keratoconus. J Refract Surg. 2017 May 1;33(5):290-297. doi: 10.3928/1081597X-20170201-02. PMID: 28486719.
23. Mazzotta C, Sgheri A, Bagaglia SA, Rechichi M, Di Maggio A. Customized corneal crosslinking for treatment of progressive keratoconus: Clinical and OCT outcomes using a transepithelial approach with supplemental oxygen. J Cataract Refract Surg. 2020 Dec;46(12):1582-1587. doi: 10.1097/j.jcrs.0000000000000347. PMID: 32858580.
24. Kamiya K, Kanayama S, Takahashi M, Shoji N. Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus. J Clin Med. 2020 Oct 8;9(10):3222. doi: 10.3390/jcm9103222. PMID: 33049990; PMCID: PMC7600308.
25. Gil JQ, Rosa AM, Costa E, Quadrado MJ, Murta JN. Customized corneal crosslinking with excimer laser-assisted epithelium removal for progressive keratoconus: 1-year results. J Cataract Refract Surg. 2023 Jun 1;49(6):602-607. doi: 10.1097/j.jcrs.0000000000001166. PMID: 36779807.
26. Seiler TG, Fischinger I, Koller T, Zapp D, Frueh BE, Seiler T. Customized Corneal Cross-linking: One-Year Results. Am J Ophthalmol. 2016 Jun;166:14-21. doi: 10.1016/j.ajo.2016.02.029. Epub 2016 Mar 2. PMID: 26944278.
27. Dupps WJ Jr. Corneal crosslinking: Stabilization or rehabilitation? J Cataract Refract Surg. 2018 May;44(5):525-527. doi: 10.1016/j.jcrs.2018.05.005. PMID: 29891152; PMCID: PMC6041123.
28. Webb JN, Langille E, Hafezi F, Randleman JB, Scarcelli G. Biomechanical Impact of Localized Corneal Cross-linking Beyond the Irradiated Treatment Area. J Refract Surg. 2019 Apr 1;35(4):253-260. doi: 10.3928/1081597X-20190304-01. PMID: 30984983; PMCID: PMC6551604.
29. Doctor K, Vunnava KP, Shroff R, Kaweri L, Lalgudi VG, Gupta K, Kundu G. Simplifying and understanding various topographic indices for keratoconus using Scheimpflug based topographers. Indian J Ophthalmol. 2020 Dec;68(12):2732-2743. doi: 10.4103/ijo.IJO_2111_20. PMID: 33229649; PMCID: PMC7856941.
30. Hayek J, Viberg A, Elving S, Fredriksson A, Behndig A. Effects of customized corneal cross-linking on higher-order aberrations in progressive keratoconus and low-grade myopia. Acta Ophthalmol. 2025 Dec;103(8):966-973. doi: 10.1111/aos.17432. Epub 2024 Dec 19. PMID: 39698801; PMCID: PMC12604442.
31. Liu Z, Dai Z, Zhang H, Chen Y. Characteristics influencing visual outcomes of corneal topography-guided excimer laser keratectomy combined with corneal cross-linking for keratoconus. Photodiagnosis Photodyn Ther. 2026 Jun 22;60:105552. doi: 10.1016/j.pdpdt.2026.105552. Epub ahead of print. PMID: 42331080.
32. Shetty R, Pahuja N, Roshan T, Deshmukh R, Francis M, Ghosh A, Sinha Roy A. Customized Corneal Cross-linking Using Different UVA Beam Profiles. J Refract Surg. 2017 Oct 1;33(10):676-682. doi: 10.3928/1081597X-20170621-07. PMID: 28991335.
33. Statsenko Y, Smetanina D, Voitetskii R, Simiyu GL, Pazniak M, Likhorad E, Pazniak A, Beliakouski P, Abelski D, Ismail F, Neidl-Van Gorkom K, Ljubisavljevic M. Digital transformation of care for keratoconus patients: ML modeling structural outcomes of corneal collagen cross-linking. Front Med (Lausanne). 2025 Jun 4;12:1462653. doi: 10.3389/fmed.2025.1462653. PMID: 40534684; PMCID: PMC12174071.
2. Maharana PK, Dubey A, Jhanji V, Sharma N, Das S, Vajpayee RB. Management of advanced corneal ectasias. Br J Ophthalmol. 2016 Jan;100(1):34-40. doi: 10.1136/bjophthalmol-2015-307059. Epub 2015 Aug 20. PMID: 26294106.
3. Asimellis G, Kaufman EJ. Keratoconus. 2024 Apr 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. PMID: 29262160.
4. Wolle MA, Randleman JB, Woodward MA. Complications of Refractive Surgery: Ectasia After Refractive Surgery. Int Ophthalmol Clin. 2016 Spring;56(2):127-39. doi: 10.1097/IIO.0000000000000102. PMID: 26938343; PMCID: PMC4780337.
5. Sinha Roy A, Dupps WJ Jr. Patient-specific computational modeling of keratoconus progression and differential responses to collagen cross-linking. Invest Ophthalmol Vis Sci. 2011 Nov 25;52(12):9174-87. doi: 10.1167/iovs.11-7395. PMID: 22039252; PMCID: PMC3253542.
6. Wang C, Lou Y, Ye Y, Shen S, Bao F, Wang J, Elsheikh A. Evaluating corneal cross-linking using Stress-Strain Index maps: a finite element study. J R Soc Interface. 2025 Aug;22(229):20250234. doi: 10.1098/rsif.2025.0234. Epub 2025 Aug 27. PMID: 40858243; PMCID: PMC12380491.
7. Frigelli M, Ariza Gracia MA, Aydemir ME, Torres-Netto EA, Hafezi F, Rozema J, Büchler P, Kling S. Predicting the Effects of Customized Corneal Cross-Linking on Corneal Geometry. Invest Ophthalmol Vis Sci. 2025 Sep 2;66(12):51. doi: 10.1167/iovs.66.12.51. PMID: 40985801; PMCID: PMC12468094.
8. Hsu JH, Tsai TH, Lin TW. Clinical Outcomes and Safety of Customized Corneal Cross-linking for Keratoconus: A Systematic Review and Meta-analysis. J Refract Surg. 2026 May;42(5):e496-e507. doi: 10.3928/1081597X-20260216-01. Epub 2026 May 1. PMID: 42113928.
9. Nordström M, Schiller M, Fredriksson A, Behndig A. Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results. Br J Ophthalmol. 2017 Jul;101(7):920-925. doi: 10.1136/bjophthalmol-2016-309210. Epub 2016 Nov 29. PMID: 27899371.
10. Godefrooij DA, Gans R, Imhof SM, Wisse RP. Nationwide reduction in the number of corneal transplantations for keratoconus following the implementation of cross-linking. Acta Ophthalmol. 2016 Nov;94(7):675-678. doi: 10.1111/aos.13095. Epub 2016 May 23. PMID: 27213687.
11. Jadidi K, Mosavi SA, Nejat F, Mohammadi N, Aghamolaei H, Daryabari SH, Torabi H, Alishiri A. Use of low-vault posterior chamber collagen copolymer phakic intraocular lenses for the correction of myopia: a 3-year follow-up. Graefes Arch Clin Exp Ophthalmol. 2019 Jul;257(7):1555-1560. doi: 10.1007/s00417-019-04336-9. Epub 2019 May 27. PMID: 31131424.
12. Alkhabbaz AA, Karam MH, Pollmann AS, Nath S, Lau THA, Al-Awadhi H, Abbas K, Jabbour S. Safety and Efficacy of Posterior Chamber Phakic Implantable Collamer Lenses in Patients with Keratoconus: A Systematic Review and Meta-Analysis. Am J Ophthalmol. 2025 Mar;271:222-232. doi: 10.1016/j.ajo.2024.11.013. Epub 2024 Nov 28. PMID: 39613132.
13. Jin Y, McAlinden C, Sun Y, Wen D, Wang Y, Yu J, Feng K, Song B, Wang Q, Chen S, Huang J. Sirius Scheimpflug-Placido versus ultrasound pachymetry for central corneal thickness: meta-analysis. Eye Vis (Lond). 2021 Feb 18;8(1):5. doi: 10.1186/s40662-021-00227-5. PMID: 33602345; PMCID: PMC7891160.
14. Ruiz-Belda C, Piñero DP, Ruiz-Fortes P, Soto-Negro R, Moya M, Pérez-Cambrodí RJ, Artola A. Intra-session repeatability of iridocorneal angle measurements provided by a Scheimpflug photography-based system in healthy eyes. Graefes Arch Clin Exp Ophthalmol. 2016 Jan;254(1):169-75. doi: 10.1007/s00417-015-3105-0. Epub 2015 Jul 15. PMID: 26174969.
15. Sahu J. Corneal topography: sirius. Delhi Journal Of Ophthalmology. 2021 Oct 1;32(2):119-24. doi: 10.7869/djo.731.
16. Gomes JA, Tan D, Rapuano CJ, Belin MW, Ambrósio R Jr, Guell JL, Malecaze F, Nishida K, Sangwan VS; Group of Panelists for the Global Delphi Panel of Keratoconus and Ectatic Diseases. Global consensus on keratoconus and ectatic diseases. Cornea. 2015 Apr;34(4):359-69. doi: 10.1097/ICO.0000000000000408. PMID: 25738235.
17. Tsai PS, Dowidar A, Naseri A, McLeod SD. Predicting time to refractive stability after discontinuation of rigid contact lens wear before refractive surgery. J Cataract Refract Surg. 2004 Nov;30(11):2290-4. doi: 10.1016/j.jcrs.2004.05.021. PMID: 15519077.
18. McAlinden C, Lockington D. Cessation of contact lenses prior to corneal tomography for keratoconus monitoring: results from a clinician survey. Eye (Lond). 2024 Dec;38(18):3603-3604. doi: 10.1038/s41433-024-03352-2. Epub 2024 Oct 11. PMID: 39394369; PMCID: PMC11621536.
19. Goudie C, Tatham A, Davies R, Sifton A, Wright M. The effect of the timing of the cessation of contact lens use on the results of biometry. Eye (Lond). 2018 Jun;32(6):1048-1054. doi: 10.1038/s41433-018-0019-1. Epub 2018 Feb 2. PMID: 29391575; PMCID: PMC5997671.
20. Kanclerz P, Khoramnia R, Wang X. Current Developments in Corneal Topography and Tomography. Diagnostics (Basel). 2021 Aug 13;11(8):1466. doi: 10.3390/diagnostics11081466. PMID: 34441401; PMCID: PMC8392046.
21. Nasser CK, Singer R, Barkana Y, Zadok D, Avni I, Goldich Y. Repeatability of the Sirius imaging system and agreement with the Pentacam HR. J Refract Surg. 2012 Jul;28(7):493-7. doi: 10.3928/1081597X-20120619-01. PMID: 22767167.
22. Cassagne M, Pierné K, Galiacy SD, Asfaux-Marfaing MP, Fournié P, Malecaze F. Customized Topography-Guided Corneal Collagen Cross-linking for Keratoconus. J Refract Surg. 2017 May 1;33(5):290-297. doi: 10.3928/1081597X-20170201-02. PMID: 28486719.
23. Mazzotta C, Sgheri A, Bagaglia SA, Rechichi M, Di Maggio A. Customized corneal crosslinking for treatment of progressive keratoconus: Clinical and OCT outcomes using a transepithelial approach with supplemental oxygen. J Cataract Refract Surg. 2020 Dec;46(12):1582-1587. doi: 10.1097/j.jcrs.0000000000000347. PMID: 32858580.
24. Kamiya K, Kanayama S, Takahashi M, Shoji N. Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus. J Clin Med. 2020 Oct 8;9(10):3222. doi: 10.3390/jcm9103222. PMID: 33049990; PMCID: PMC7600308.
25. Gil JQ, Rosa AM, Costa E, Quadrado MJ, Murta JN. Customized corneal crosslinking with excimer laser-assisted epithelium removal for progressive keratoconus: 1-year results. J Cataract Refract Surg. 2023 Jun 1;49(6):602-607. doi: 10.1097/j.jcrs.0000000000001166. PMID: 36779807.
26. Seiler TG, Fischinger I, Koller T, Zapp D, Frueh BE, Seiler T. Customized Corneal Cross-linking: One-Year Results. Am J Ophthalmol. 2016 Jun;166:14-21. doi: 10.1016/j.ajo.2016.02.029. Epub 2016 Mar 2. PMID: 26944278.
27. Dupps WJ Jr. Corneal crosslinking: Stabilization or rehabilitation? J Cataract Refract Surg. 2018 May;44(5):525-527. doi: 10.1016/j.jcrs.2018.05.005. PMID: 29891152; PMCID: PMC6041123.
28. Webb JN, Langille E, Hafezi F, Randleman JB, Scarcelli G. Biomechanical Impact of Localized Corneal Cross-linking Beyond the Irradiated Treatment Area. J Refract Surg. 2019 Apr 1;35(4):253-260. doi: 10.3928/1081597X-20190304-01. PMID: 30984983; PMCID: PMC6551604.
29. Doctor K, Vunnava KP, Shroff R, Kaweri L, Lalgudi VG, Gupta K, Kundu G. Simplifying and understanding various topographic indices for keratoconus using Scheimpflug based topographers. Indian J Ophthalmol. 2020 Dec;68(12):2732-2743. doi: 10.4103/ijo.IJO_2111_20. PMID: 33229649; PMCID: PMC7856941.
30. Hayek J, Viberg A, Elving S, Fredriksson A, Behndig A. Effects of customized corneal cross-linking on higher-order aberrations in progressive keratoconus and low-grade myopia. Acta Ophthalmol. 2025 Dec;103(8):966-973. doi: 10.1111/aos.17432. Epub 2024 Dec 19. PMID: 39698801; PMCID: PMC12604442.
31. Liu Z, Dai Z, Zhang H, Chen Y. Characteristics influencing visual outcomes of corneal topography-guided excimer laser keratectomy combined with corneal cross-linking for keratoconus. Photodiagnosis Photodyn Ther. 2026 Jun 22;60:105552. doi: 10.1016/j.pdpdt.2026.105552. Epub ahead of print. PMID: 42331080.
32. Shetty R, Pahuja N, Roshan T, Deshmukh R, Francis M, Ghosh A, Sinha Roy A. Customized Corneal Cross-linking Using Different UVA Beam Profiles. J Refract Surg. 2017 Oct 1;33(10):676-682. doi: 10.3928/1081597X-20170621-07. PMID: 28991335.
33. Statsenko Y, Smetanina D, Voitetskii R, Simiyu GL, Pazniak M, Likhorad E, Pazniak A, Beliakouski P, Abelski D, Ismail F, Neidl-Van Gorkom K, Ljubisavljevic M. Digital transformation of care for keratoconus patients: ML modeling structural outcomes of corneal collagen cross-linking. Front Med (Lausanne). 2025 Jun 4;12:1462653. doi: 10.3389/fmed.2025.1462653. PMID: 40534684; PMCID: PMC12174071.
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