Standard versus accelerated riboflavin–ultraviolet corneal collagen crosslinking: Resistance against enzymatic digestion

Abstract

PurposeTo examine the effect of standard and accelerated corneal collagen crosslinking (CXL) on corneal enzymatic resistance.SettingSchool of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom.DesignExperimental study.MethodsSixty-six enucleated porcine eyes (with corneal epithelium removed) were assigned to 6 groups. Group 1 remained untreated, group 2 received dextran eyedrops, and groups 3 to 6 received riboflavin/dextran eyedrops. Group 4 had standard CXL (3 mW/cm2 ultraviolet-A for 30 minutes), whereas groups 5 and 6 received accelerated CXL (9 mW/cm2 for 10 minutes and 18 mW/cm2 for 5 minutes, respectively). Trephined central 8.0 mm buttons from each cornea underwent pepsin digestion. Corneal diameter was measured daily, and the dry weight of 5 samples from each group was recorded after 12 days of digestion.ResultsAll CXL groups (4 to 6) took longer to digest and had a greater dry weight at 12 days (P < .0001) than the nonirradiated groups (1 to 3) (P < .0001). The time taken for complete digestion to occur did not differ between the standard and accelerated CXL groups, but the dry weights at 12 days showed significant differences between treatments: standard CXL 3 mW > accelerated CXL 9 mW > accelerated CXL 18 mW (P < .0001).ConclusionsStandard and accelerated CXL both increased corneal enzymatic resistance; however, the amount of CXL might be less when accelerated CXL is used. The precise amount of CXL needed to prevent disease progression is not yet known.Financial DisclosureNo author has a financial or proprietary interest in any material or method mentioned.