Biomechanical Changes after in vivo Enzyme-Induced Corneal Crosslinking in Rabbits

Introduction:Enzyme-induced corneal crosslinking (CXL) may be a promising and effective method to stiffen the cornea. However, there have been no reports on the effect of corneal CXL with enzyme in vivo.Objective:To evaluate the biomechanical efficacy after in vivo enzyme-induced corneal CXL in rabbits using noninvasive imaging.Methods:The eyes of 10 white New Zealand rabbits were unilaterally treated with CXL enzyme (transglutaminases [Tgases]). The contralateral eyes served as negative controls. In every rabbit, a 1 U/mL solution of Tgases was applied to the corneal surface. Corneal dynamic deformation by an air puff was measured using high-speed Scheimpflug imaging on day 14 after the procedure. Biomechanical parameters, central corneal thickness, and intraocular pressure were recorded and assessed. Then, corneal buttons were excised from euthanized animals for hematoxylin and eosin staining to evaluate changes in corneal collagen distribution and cell damage.Results:Some biomechanical parameters showed statistically significant changes after in vivo CXL. The deformation amplitude and maximum corneal velocity during the second applanations were significantly lower than those of the untreated control group. The second applanations were significantly increased compared to the control group. No changes were found in other parameters. The morphology of the corneal stroma was similar in CXL-treated and untreated corneas. No obvious cell apoptosis was observed.Conclusions:Corneal stiffness increased after in vivo CXL induced by Tgases. This CXL method may be useful for corneal ectasia.