Purpose: To evaluate ex vivo the possible difference in corneal cross-linking (CXL) biomechanical effect of different ultraviolet-A (UV-A) irradiances.
Methods: The study involved 25 human donor corneas, randomly allocated to 5 groups (n = 5 each). CXL was applied with UV-A irradiances of 3, 9, 18, 30, and 45 mW/cm2, maintaining equal cumulative energy dose of 5.4 J/cm2. UV-A was delivered on half of the cornea. The nonirradiated halves served as controls. Specimens were subjected to collagenase-A enzymatic digestion. The time to complete dissolution in each specimen was recorded.
Results: Time to dissolution in group-A (3 mW/cm2 for 30 minutes) was 321 ± 13.4 minutes (range: 300-330) compared with 171 ± 8.2 (range: 165-180) for their control. In group-B (9 mW/cm2 for 10 minutes), it was 282 ± 19.6 minutes (range: 270-315) compared with 177 ± 6.7 (165-180) for their control. In group-C (18 mW/cm2 for 5 minutes), it was 267 ± 19.6 minutes (range: 240-285) compared with 177 ± 7.7 (range: 165-180) for their control. In group-D (30 mW/cm2 for 3 minutes), it was 252 ± 12.5 minutes (range: 240-270) compared with 180 ± 10.6 minutes (range: 165-195) for their control. In group-E (45 mW/cm2 for 2 minutes), it was 204 ± 17.1 minutes (range: 180-225) compared with 186 ± 8.2 minutes (range: 180-195) for their control.
Conclusions: The data in this ex vivo human corneal study indicate that the biomechanical effect of CXL studied by resistance to enzymatic digestion in human corneas is comparable between irradiances of 9, 18 and 30 mW/cm and seems to be reduced at a fluence of 45 mW/cm2.