Impact of Temperature on the Biomechanical Effect in Epithelium-Off Corneal Cross-Linking | ASCRS
Presentation
Impact of Temperature on the Biomechanical Effect in Epithelium-Off Corneal Cross-Linking
May 2020
Meeting: 2020 Virtual Annual Meeting
Session: SPS-106 Keratoconus: Measurements, Treatments, New Technology
Authors: Hormoz Abdshahzadeh, Sr., MD, Farhad Hafezi PhD, MD, J. Bradley Randleman MD, Francesca Gilardoni MD, Emilio Torres Netto MD, Reyhaneh Abrishamchi MD
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Purpose
Oxygen diffusion has a central role in the efficiency of corneal cross-linking. Oxygen availability in tissue increases with reduced temperature. The goal of this study was to assess whether a reduction of the corneal temperature during CXL might raise oxygen availability and thus enhance the biomechanical effect of CXL in ex vivo porcine corneas.

Methods
One hundred twelve porcine corneas with intact epithelium were divided into 4 groups and analyzed. Prior to corneal soaking with hypo-osmolaric 0.1% riboflavin, the epithelium was removed manually in all groups. Accelerated epithelium-off CXL using 9 mW/cm2 irradiance for 10 minutes was performed either at room temperature (group 1, 24°C) or in a cold room (group3, 4°C). Non-cross-linked corneas (groups 2 and 4) were subjected to the same temperatures and served as controls. The elastic modulus of 5-mm wide corneal strips was analyzed and used to determine corneal biomechanical properties.

Results
Epithelium-off CXL led to significant increases in the elastic modulus determined between 1% and 5% of strain in stress-strain extensometry when compared to non-cross-linked controls, both at 24°C (p<0.001) and 4°C (p=0.006) . However, no significant difference was found between corneas treated with CXL at 24°C and 4°C (p = 0.384).

Conclusion
While oxygen plays a central role in corneal cross-linking, the potentially increased diffusion of oxygen in lower tissue temperatures does not appear to play a significant role in the biomechanical efficiency of epithelium-off CXL accelerated protocols in ex vivo porcine corneas.
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This presentation is from the session "SPS-106 Keratoconus: Measurements, Treatments, New Technology" from the 2020 ASCRS Virtual Annual Meeting held on May 16-17, 2020.

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