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On the cellular level, a complex interplay of hormonal changes, alterations in enzymatic activity that modify extracellular membrane stiffness, and changes in biochemical and biomechanical signalling pathways disrupt collagen cross-linking within the stroma, contributing to structural integrity loss and distortion of normal corneal anatomy

Methionine** Helps break down sugars & carbohydrates and convert them into energy

Author contributions YL: Data curation, Methodology, Investigation, Writing review & editing, Formal analysis, Writing original draft, Project administration

MMPs, such as MMP-2 and MMP-9, are activated by pro-inflammatory cytokines and degrade components of the extracellular matrix, thereby disrupting tissue integrity and enhancing inflammation through activation of NF-B and activating protein-1 (AP-1) signaling pathways (3840)