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

PURPOSE: To examine the effect of standard and accelerated corneal collagen crosslinking (CXL) on corneal enzymatic resistance. SETTING: School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom. DESIGN: Experimental study. METHODS: Sixty-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/cm(2) ultraviolet-A for 30 minutes), whereas groups 5 and 6 received accelerated CXL (9 mW/cm(2) for 10 minutes and 18 mW/cm(2) 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. RESULTS: All 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). CONCLUSIONS: Standard 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 DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.