Zhang and Zhang offered some comments regarding our study. First, they mentioned that the epithelial-on technique halts the progression of ectasia cases and cited the work of Filippello et al. However, the study by Filippello et al has a major limitation similar to ours, which is 1-year follow-up. Therefore, the results of the mentioned reference cannot be adopted as an absolute fact, as further studies with larger numbers of patients followed for longer periods are needed. Second, other studies regarding transepithelial cross-linking (CXL) have shown that this procedure had a limited effect in comparison with traditional CXL, and per Caporos-si et al, "according to limited penetration, its mid- to long-term efficacy needs to be determined in different clinical settings related to patient age and keratoconus progression."
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