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Current Eye Research Volume 45, 2020 - Issue 6
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Sclera

Differential Regional Stiffening of Sclera by Collagen Cross-linking

Bola A. GawargiousDepartment of Integrative Biology and Physiology, University of California, Los Angeles, California, USAView further author information
,
Alan LeDepartment of Ophthalmology, University of California, Los Angeles, California, USA;Stein Eye Institute, University of California, Los Angeles, California, USA;Neuroscience and Bioengineering Interdepartmental Programs, University of California, Los Angeles, California, USAView further author information
,
Michael LesgartDepartment of Psychology, University of California, Los Angeles, California, USAView further author information
,
Shoaib UgradarDepartment of Ophthalmology, University of California, Los Angeles, California, USA;Stein Eye Institute, University of California, Los Angeles, California, USAORCID Iconhttps://orcid.org/0000-0003-4479-3033View further author information
ORCID Icon &
Joseph L. DemerDepartment of Ophthalmology, University of California, Los Angeles, California, USA;Stein Eye Institute, University of California, Los Angeles, California, USA;Neuroscience and Bioengineering Interdepartmental Programs, University of California, Los Angeles, California, USA;Department of Neurology, University of California, Los Angeles, California, USA;David Geffen Medical School, University of California, Los Angeles, California, USACorrespondence[email protected]
View further author information
Pages 718-725 | Received 29 Aug 2019, Accepted 07 Nov 2019, Published online: 21 Nov 2019
 
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ABSTRACT

Purpose: Corneal collagen cross-linking by ultraviolet light activation of riboflavin has been used clinically to enhance corneal stiffness. We sought to determine if cross-linking differentially affects scleral regions.

Methods: Adjacent, parallel strips of sclera were cut from superolateral, superomedial, inferolateral, and inferomedial quadrants of posterior and equatorial sclera of 12 human cadaver eyes. One of each pair served as control while the other was cross-linked by immersion in 0.1% riboflavin and 365 nm exposure at 6 mW/cm2 irradiance for 30 min. Behavior of strips was characterized using a microtensile load cell. Preloaded strips were imaged using orthogonally mounted cameras and optical coherence tomography to determine specimen dimensions including cross-sectional area. Tension was measured during 0.1 mm/s constant rate elongation.

Results: Young’s modulus (YM), the slope of the relationship relating tensile stress to strain, was calculated at 8% strain, and increased significantly after cross-linking (P < .001). In posterior sclera, mean (± standard error of mean, SEM) YM is increased in the superolateral, superomedial, inferolateral, and inferomedial quadrants by 46 ± 15%, 32 ± 11%, 67 ± 20%, and 53 ± 11%, respectively. In equatorial sclera, YM is increased by 139 ± 43%, 68 ± 27%, 143 ± 92%, and 68 ± 14%, respectively. The YM of pooled equatorial quadrants increased significantly more than that of the pooled posterior quadrants.

Conclusions: Scleral collagen cross-linking by ultraviolet activation of riboflavin differentially increases scleral YM more in the equatorial than posterior sclera, and most in the lateral, equatorial sclera. Cross-linking might be used to arrest progressive myopia or to prevent staphyloma formation.

Disclosure Statement

None of the authors has a financial interest in any material related to this paper.

Additional information

Funding

USPHS EY008313 and an Unrestricted Grant from Research to Prevent Blindness to the Department of Ophthalmology.

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