Reduction of stromal swelling pressure after UVA-riboflavin cross-linking

We evaluated whether UVA-riboflavin collagen cross-linking (CXL) reduces stromal swelling pressure (SP) in porcine and human corneas ex vivo.

Porcine corneas (N = 35) were divided into five groups: Full-thickness buttons, riboflavin-treated buttons, CXL-treated buttons, riboflavin-treated anterior and posterior lamellae, and CXL-treated anterior and posterior lamellae. Riboflavin- or CXL-treated human corneas (n = 6) were cut into anterior and posterior lamellae. The force exerted by the specimens during swelling in saline was recorded and SP was calculated. Dry weights were obtained for solids correction.

In full-thickness porcine buttons, a significantly reduced SP was observed after CXL (40.07 ± 3.86 mm Hg) compared to riboflavin treatment (68.13 ± 11.39 mm Hg, P = 0.02) at 5% compression. Also, a trend toward reduced SP in the CXL-treated anterior human lamellae (9.9 mm Hg) was found compared to the riboflavin group (25 mm Hg) at 5% compression. In the anterior porcine lamellae a significant SP reduction was observed in the CXL group versus the riboflavin group (P < 0.001, two-way ANOVA). Likewise, in the posterior porcine lamellae, a significant SP reduction was observed in the CXL group versus riboflavin alone (P < 0.05, two-way ANOVA). Posterior human lamellae did not differ in SP when comparing CXL and riboflavin groups.

Our study demonstrated a significant reduction in anterior stromal SP in porcine and human corneas after CXL. This finding suggested that CXL may reduce corneal SP in vivo, and thereby reduce edema and improve vision. Thus, in the clinical setting, patients suffering from corneal edema may benefit from CXL treatment.