Collagen cross-linking treatment effects on corneal dynamic biomechanical properties

Cornea is a soft tissue with the principal function of transmitting and refracting light rays. The objective of the current study was to characterize possible effects of the riboflavin/UVA collagen cross-linking on corneal dynamic properties. The original corneal cross-linking protocol was used to induce cross-links in the anterior portion of the bovine cornea. A DMA machine was used to conduct mechanical tensile experiments at different levels of tensile strains. The samples were divided into a control group (n = 5) and a treated group (n = 5). All specimens were first stretched to a strain of 5% and allowed to relax for twenty minutes. After completion of the stress-relaxation experiment, a frequency sweep test with oscillations ranging from 0.01 to 10 Hz was performed. The same procedure was repeated to obtain the stress-relaxation and dynamic properties at 10% strain. It was observed that the collagen cross-linking therapy significantly increased the immediate and equilibrium tensile behavior of the bovine cornea (P < 0.05). Furthermore, for all samples in control and treated groups and throughout the whole range of frequencies, a significantly larger tensile storage modulus was measured at an axial strain of 10% compared to what was obtained at a tensile strain of 5%. Finally, it was noted that although this treatment procedure resulted in a significant increase in the storage and loss modulus at any axial strain and frequency (P < 0.05), it significantly reduced the ratio of the dissipated and stored energy during a single cycle of deformation. Therefore, it was concluded that while the riboflavin/UVA collagen cross-linking increased significantly corneal stiffness, it decreased significantly its damping capability and deformability. This reduced damping ability might adversely interfere with corneal mechanical performance.