Iontophoresis Corneal Cross-linking With Oxygen Supplementation in Ovine Eyes.

PURPOSE: To evaluate the biomechanical changes and advanced oxidation protein products (AOPP) production after different corneal cross-linking (CXL) protocols with or without oxygen supplementation. METHODS: Ovine eyes in the study were equally distributed to five groups as control, standard Dresden protocol, diluted alcohol- and iontophoresis-assisted CXL (DAI-CXL), and 0.1% and 0.2% riboflavin-mediated iontophoresis-assisted CXL with oxygen supplementation (I-CXL). Corneas that received CXL were divided into two equal parts, one part was used for uniaxial tensiometry and one part was used for AOPP measurement. RESULTS: All treatment groups showed higher Young's modulus and stiffness compared to the control group (P < .05). Both oxygen-assisted I-CXL groups with 0.1% and 0.2% riboflavin concentrations had higher corneal Young's modulus (P = .009 and .006, respectively) and stiffness (P = .009) values, whereas the DAI-CXL group had lesser Young's modulus and stiffness values (P = .032) compared to the Dresden protocol group. All treatment groups showed higher AOPP concentrations compared to the control group (P < .05). DAI-CXL and I-CXL groups showed similar AOPP formation compared to the Dresden protocol (P = .673). CONCLUSIONS: When the epithelium is intact, the desired increase in corneal stiffness might not be achieved. However, increasing the oxygen in the environment might provide a sufficient increase in stiffness in cases undergoing epitheliumon I-CXL, which might be promising in terms of shortening the CXL therapy and decreasing the complications. [J Refract Surg. 2022;38(10):674-681.].

Iontophoresis-Assisted Rose Bengal and Green Light Corneal Cross-Linking.

PURPOSE: To evaluate the effects of the application of iontophoresis-assisted rose bengal and green light cross-linking (I-RGX) therapy on enucleated rabbit eyes for corneal biomechanical parameters, dye diffusion rates, and green light levels reaching deep tissues and to compare these parameters with a standard rose bengal and green light cross-linking (RGX) therapy. METHOD: Forty-five enucleated rabbit eyes were used in this study. To evaluate biomechanical changes, corneas were divided into the following 4 groups: the control group, the 0.1% rose bengal application group, the RGX group (100 J/cm), and the I-RGX group (100 J/cm). After this, corneal strips were evaluated with a uniaxial extensometer. To assess corneal dye diffusion, postprocedure dye depth was recorded with anterior segment optic coherence tomography. The amount of irradiation passing through the cornea during irradiation with 250 mW/cm irradiation power was measured with a laser power meter at the first, third, and seventh minutes. RESULTS: In the I-RGX-treated group especially, the mean elastic modulus and corneal stiffness values were about 4.7 times higher when compared with the controls and about 2.2 times higher than those in the RGX group. The rose bengal diffusion depth was 26.63% ± 3.84% of the total corneal thickness in the rose bengal drop group, but this value increased to 42.22% ± 4.77% in the iontophoresis group (<0.001). After iontophoresis, an average of 98% of the 100 J/cm green light was kept in the cornea. CONCLUSIONS: I-RGX is a very useful method for increasing corneal biomechanical strength and is highly effective in increasing the amount of corneal dye diffusion into the cornea while also minimalizing the amount of laser passage reaching deeper tissues.