Assessment of a Novel Corneal-Shaping Device With Simultaneous Corneal Collagen Cross-Linking Using a Porcine Eye Model.
OBJECTIVE
Corneal collagen cross-linking (CXL) alone cannot substantially improve refractive errors. We designed a novel corneal-shaping device, showing that a prototype applied during CXL can alter corneal curvature to a greater extent than CXL alone in a porcine eye model.


METHODS
The device prototype was made with flat, UV-transmissible material. Enucleated porcine eyes were deepithelialized and perfused. Preexperimental and postexperimental corneal curvature (K) measurements and Anterior Segment Optical Coherence Tomography imaging were performed. A conventional CXL protocol was followed. Six experiments of 6 treatment groups in duplicate were performed (n = 12/group): (A) no CXL + no device, (B) no CXL + 30 minutes device, (C) 10 minutes, CXL + no device, (D) 10 minutes, CXL + device, (E) 30 minutes, CXL + no device, and (F) 30 minutes, CXL + device.


RESULTS
There was a significant decrease (P < 0.001) in corneal curvature after 30 minutes. CXL between group F (-1.54 ± 0.90 D) and groups E (+0.34 ± 0.53 D), B (+0.69 ± 1.02 D), or A (+0.22 ± 1.24 D). The demarcation line depth was greater in group F (34% ± 4%) than group D (30% ± 4%, P < 0.05). Groups D (-2.3% ± 21%) and F (0.24% ± 15%) had less change in corneal thickness than in control groups A (15% ± 12%, P < 0.05) and E (12% ± 11%, P < 0.05).


CONCLUSIONS
Application of our corneal-shaping device during CXL significantly decreased corneal curvature compared with controls. Anterior Segment Optical Coherence Tomography imaging showed comparable extent of cross-linking in eyes treated ± device. This demonstrates that our novel device used during CXL may further promote corneal strengthening and refractive correction in patients.
*Case Western Reserve University School of Medicine, Cleveland, OH; †Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD; ‡Borkenstein & Borkenstein, Fachaerzte fuer Augenheilkunde, Graz, Austria; and §Translational Tissue Engineering Center, Johns Hopkins Medical Institutions, Baltimore, MD.
Angela Y
AY
Zhu
Lucas M M
LM
Vianna
Eva-Maria
EM
Borkenstein
Jennifer
J
Elisseeff
Albert S
AS
Jun
D000818:Animals; D003094:Collagen / Q000627:therapeutic use*; D003315:Cornea / Q000378:metabolism*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D004195:Disease Models, Animal; D007640:Keratoconus / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D013552:Swine; D041623:Tomography, Optical Coherence / Q000379:methods
D003432:Cross-Linking Reagents; D003094:Collagen