title: BAC-EDTA transepithelial riboflavin-UVA crosslinking has greater biomechanical stiffening effect than standard epithelium-off in rabbit corneas.
abstract: Studies suggest that standard corneal collagen crosslinking (CXL) is a safe and effective treatment to stiffen the cornea for keratoconus and other ectatic corneal disorders. The purpose of the present study was to compare the biomechanical effects of transepithelial benzalkonium chloride-EDTA (BAC-EDTA) riboflavin-UVA crosslinking to standard epithelium-off riboflavin-UVA crosslinking in a rabbit model. Corneal stiffness was quantified using optical coherence elastography at two months after treatment. The mean lateral-to-axial displacement ratio for the BAC-EDTA transepithelial CXL group was lower (greater stiffness) [0.062 ± 0.042, mean ± SD] than epithelium-off CXL (mean ± SD: 0.065 ± 0.045) or untreated control eyes (0.069 ± 0.044). Using ANOVA with Tukey correction, a statistically significant difference was found between the BAC-EDTA transepithelial CXL group and standard epithelium-off CXL (p = 0.0019) or the untreated control (p < 0.0001) groups. A graph of the probability density functions for biomechanical stiffness also showed a greater shift in stiffening in the BAC-EDTA transepithelial CXL group than the standard epithelium-off CXL or untreated control group. These results demonstrated that the biomechanical stiffening effect produced by BAC-EDTA transepithelial CXL was greater than that produced by standard epithelium-off CXL in a rabbit model.
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Andre A M
authors.initials: AA
authors.lastname: Torricelli
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Ford
authors.affiliation: LV Prasad Eye Institute, HERF, Hyderabad, AP, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Singh
authors.affiliation: University of Sao Paulo, Sao Paulo, Brazil; Federal University of Rio de Janeiro, Brazil.
authors.forename: Marcony R
authors.initials: MR
authors.lastname: Santhiago
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Dupps
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: wilsons4@ccf.org.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wilson
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001548:Benzalkonium Compounds / Q000494:pharmacology; D001696:Biomechanical Phenomena / Q000502:physiology; D002614:Chelating Agents / Q000494:pharmacology; D003315:Cornea / Q000187:drug effects* / Q000503:physiopathology; D003432:Cross-Linking Reagents / Q000494:pharmacology*; D004548:Elasticity / Q000187:drug effects* / Q000502:physiology; D054459:Elasticity Imaging Techniques; D023421:Models, Animal; D017319:Photosensitizing Agents / Q000494:pharmacology*; D011817:Rabbits; D012256:Riboflavin / Q000494:pharmacology*; D014466:Ultraviolet Rays
chemical_list: D001548:Benzalkonium Compounds; D002614:Chelating Agents; D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D012256:Riboflavin
keywords: biomechanical; collagen crosslinking; cornea; ectasia; riboflavin; transepithelial treatment