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Jay M. Stewart, On-Tat Lee, Fergus F. Wong, David S. Schultz, Ricardo Lamy; Cross-Linking with Ultraviolet-A and Riboflavin Reduces Corneal Permeability. Invest. Ophthalmol. Vis. Sci. 2011;52(12):9275-9278. doi: https://doi.org/10.1167/iovs.11-8155.
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To investigate the effect of cross-linking treatment on corneal permeability in a live animal model.
Rabbit eyes were selected at random to be left unoperated or to undergo epithelial debridement with or without treatment consisting of cross-linking (CXL) with riboflavin and ultraviolet-A. Nine eyes received a total dose of 3.6 J/cm2 and after epithelial healing the corneas were placed in a two-chamber system for quantification of the diffusion of fluorescein compared with controls. Thirty eyes received a total dose of 5.4 J/cm2 and, after epithelial healing, in vivo corneal permeability was quantified as the pupillary response over a 30-minute period to a dose of topical pilocarpine compared with controls.
In the ex vivo assay, the mean permeability coefficient in the CXL group (2.42 × 10−7) was reduced when compared with the unoperated controls (3.73 × 10−7; P = 0.007) and to the eyes that received epithelial debridement alone (3.74 × 10−7; P = 0.01). In the in vivo permeability assay, the change in pupillary diameter at 30 minutes after pilocarpine administration was smaller in the CXL group (−1.9 mm), compared with the epithelial debridement group (−2.6 mm; P < 0.001) and with the unoperated controls (−2.7 mm; P = 0.003).
Corneal cross-linking with ultraviolet-A and riboflavin results in a statistically significant reduction in corneal permeability. These findings suggest that dosing of topical medications may need to be increased in eyes with a history of CXL to achieve expected therapeutic effects, and they may have implications for the long-term health of the cornea.
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