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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
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An Algorithm to Predict the Biomechanical Stiffening Effect in Corneal Cross-linking.

Sabine Kling, Farhad Hafezi

    Journal of Refractive Surgery (Thorofare, N.J. : 1995)
    |February 14, 2017
    PubMed
    Summary

    This study developed an algorithm to predict corneal stiffening after corneal cross-linking (CXL). The model accurately correlates cross-link concentration with mechanical stiffening, potentially enabling customized CXL treatments.

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    Area of Science:

    • Ophthalmology
    • Biomechanical Engineering
    • Biomaterials Science

    Background:

    • Corneal cross-linking (CXL) is a therapeutic procedure to stiffen the cornea.
    • Predicting the biomechanical outcome of CXL is crucial for treatment optimization.
    • Current methods lack precise prediction of CXL-induced stiffening.

    Purpose of the Study:

    • To develop and validate a predictive algorithm for the stiffening effect of CXL.
    • To correlate algorithmic predictions with experimental biomechanical measurements.
    • To explore factors influencing CXL efficacy.

    Main Methods:

    • An algorithm was developed considering riboflavin and oxygen diffusion, and UV absorption kinetics.
    • Experimental validation involved deepithelialized porcine and rabbit corneas.
    • Stress-relaxation measurements were performed under varying CXL parameters (pulsed/continuous light, irradiance, duration).

    Main Results:

    • A strong linear correlation (R² = 0.9432) was found between cross-link concentration and stiffening.
    • Each 1 mol/m³ increase in cross-links elevated corneal stiffness by 50.4%.
    • CXL efficacy decreased by 4.1% per 100 µm corneal thickness (R² = 0.9961).

    Conclusions:

    • The predictive model, validated in animal models, shows potential for human corneal CXL efficacy prediction.
    • Optimizing CXL parameters like UV irradiation duration and oxygen availability can enhance biomechanical efficacy.
    • Pulsed CXL offers no advantage over standard CXL in terms of efficacy or acceleration.