Experimental Evaluation of Ocular Rigidity and Pressure-Volume Relationship After Ex-Vivo Scleral Cross-Linking With Riboflavin and Ultraviolet A in Porcine Eyes.

purposeScleral cross-linking (SXL) with ultraviolet A (UVA) and riboflavin has already been used in laboratory studies for scleral stiffness increase as a potential treatment for progressive myopia and scleral ectasia. This study aims to investigate whether the regional application of scleral cross-linking (SXL) with ultraviolet A (UVA) and riboflavin in fresh porcine eye globes affects the ocular rigidity as well as its impact on intraocular pressure after an induced acute increase in the volume of intraocular fluid.

methodsThe study included two groups of fresh porcine eyes: an experimental group (n=20) that underwent scleral cross-linking (SXL) with riboflavin and UVA applied to the posterior sclera and a control group (n=20) that did not receive SXL treatment. Subsequently, a balanced salt solution (volumes 50, 100, 150, and 200 μL) was administered into porcine globes via a syringe, and, at the same time, the intraocular pressure (IOP) was continuously monitored by a pressure sensor that was cannulated to the vitreous chamber. The relationship between volume and pressure was obtained, and the ocular rigidity coefficient (K) was calculated according to Friedenwald's law. Finally, scleral strips were dissected from the globes and were examined macroscopically.

resultsIn the control group, the mean IOP observed entails gradual, statistically significant increases for higher volumes. Specifically, the mean IOP at 0 μL equals 10 mmHg (SD=0), whereas at 200 μL the mean IOP equals 33.83 mmHg (SD=4.060). The differences were statistically significant with p-values <0.001 in all cases. Similarly, the observed gradual IOP increases in the SXL group were statistically significant with p < 0.001 in all cases except for the comparison of volume 0 μL measurements to volume 50 μL, where the p-value equaled 0.003. Specifically in the SXL group, the mean IOP at 0 μL equals 10.00 mmHg (SD=0.000), the mean IOP at 50 μL equals 13.31 mmHg (SD=2.011), whereas the mean IOP at 200 μL equals 32.06 mmHg (SD=3.078). At no additional injected volume, the differences between the control and the SXL groups were statistically significant. The analysis regarding ocular rigidity indicated significantly higher scores in the control group (K50=0.00812, SD=0.03) compared to the SXL group (K50=0.00552, SD=0.027), t=2.844; p=0.007. The difference regards measures of volumes 0 to 50 μL, while all other rigidity measures were found to be non-significant. Interestingly, the ocular rigidity coefficient in the SXL-treated group did not show changes with an increase in IOP. The macroscopic appearance of the scleral strips showed a significantly increased stiffness of the SXL scleras against the control ones.

conclusionThis study showed that stiffened scleras did not induce substantial change in ocular rigidity and significant IOP elevations. Studying the biomechanical ocular response of laboratory scleral crosslinking applications supports the development of next-generation crosslinking procedures that may constitute potential therapeutic options for severe ophthalmic diseases like pathologic myopia.