Excimer laser‐assisted corneal epithelial pattern ablation for corneal cross‐linking

PURPOSE: To determine corneal cross‐linking (CXL) efficacy and chromophore penetration after excimer laser‐assisted patterned de‐epithelialization. METHODS: Two‐hundred‐twenty porcine eyes were de‐epithelialized ex vivo, either fully (mechanical; n = 88) or patterned (excimer laser; n = 132). Consecutively, corneas were impregnated with hypo‐ or hyperosmolar riboflavin (RF; n = 20, RF‐D; n = 40, respectively) or water‐soluble taurine (WST11; n = 40, and WST‐D; n = 40, respectively), or kept unimpregnated (n = 80). Sixty corneas were subsequently irradiated, inducing CXL, with paired contralateral eyes serving as controls. Outcome measurements included strip extensiometry to assess CXL efficacy, and spectrophotometry and fluorescence microscopy to determine stromal chromophore penetration. RESULTS: All tested chromophores induced significant CXL (p < 0.001), ranging from 7.6% to 14.6%, with similar stiffening for all formulations (p = 0.60) and both de‐epithelialization methods (p = 0.56). Light transmittance was significantly lower (p < 0.001) after full compared with patterned de‐epithelialization. Stromal chromophore penetration was comparable between fully and patterned de‐epithelialized samples, with full penetration in RD and RF‐D samples and penetration depths measuring 591.7 ± 42.8 µm and 592.9 ± 63.5 µm for WST11 (p = 0.963) and 504.2 ± 43.2 µm and 488.8 ± 93.1 µm for WST‐D (p = 0.669), respectively. CONCLUSIONS: Excimer laser‐assisted patterned de‐epithelialization allows for effective CXL. Stromal chromophore concentration is, however, reduced, which may have safety implications given the need for sufficient UVA attenuation in RF/UVA CXL. The different safety profile of near‐infrared (NIR) may allow safe WST11/NIR CXL even with reduced stromal chromophore concentration values. In vivo studies are needed to evaluate the benefits and further assess safety of excimer laser‐assisted patterned de‐epithelialization for corneal CXL.