Aydemir, M. Enes, Kollros, Leonard, Hillen, Mark, Boote, Craig  ORCID: https://orcid.org/0000-0003-0348-6547, Meek, Keith M. ORCID: https://orcid.org/0000-0002-9948-7538, Hayes, Sally, Torres-Netto, Emilio A., Awwad, Shady T., Depczy?ska, Michalina, Hafezi, Nikki and Hafezi, Farhad
2026.
Biomechanical stiffening effect in ultra-high-fluence extracorporeal cross-linked corneal allogenic intrastromal ring segments.
Journal of Cataract and Refractive Surgery
10.1097/j.jcrs.0000000000001981
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Abstract
Purpose: To compare the biomechanical stiffening effects of a novel ultra-high fluence corneal cross-linking (CXL) protocol with conventional high-fluence CXL for extracorporeal corneal allogenic intrastromal ring segment optimization (ECO-CAIRS). Setting: ELZA Institute, Zurich, Switzerland. Design: Experimental, randomized, controlled ex vivo laboratory study using porcine corneas. No masking was applied. Methods: Eighty-four porcine corneas were divided into four groups: Group A (control), Group B (10 J/cm2), Group C (30 J/cm2), and Group D (60 J/cm2). Following epithelial debridement, Groups B, C, and D were treated with 0.1% hypo-osmolar riboflavin. UV-A irradiation was delivered at fluences of 10 J/cm2 (18 mW/cm2, 9:15 min) for Group B, 30 J/cm2 (30 mW/cm2, 16:40 min) for Group C, and 60 J/cm2 (30 mW/cm2, 33:18 min) for Group D. Corneal biomechanical properties were assessed via stress-strain extensiometry. Results: Mean elastic modulus (5% strain) values were: Group A (1.39 ± 0.49 N/mm), Group B (1.83 ± 0.48 N/mm), Group C (2.25 ± 0.83 N/mm), and Group D (2.31 ± 0.88 N/mm). Ultra-high fluence groups (C and D) showed significantly greater stiffening than Group B (P = 0.041 and P = 0.015), with no significant difference between Groups C and D (P = 1.00). Group B exhibited significantly greater stiffening than Group A (P = 0.023). Conclusions: Ultra-high fluence CXL enhances biomechanical stiffening compared to conventional high-fluence CXL, supporting its use in ECO-CAIRS. In this extracorporeal context, endothelial safety and haze are irrelevant, while increased stiffness facilitates intrastromal ring insertion and reduces corneal swelling.
| Item Type: | Article |
|---|---|
| Date Type: | Published Online |
| Status: | In Press |
| Schools: | Schools > Optometry and Vision Sciences |
| Additional Information: | RRS policy applied |
| Publisher: | Lippincott, Williams & Wilkins |
| ISSN: | 0886-3350 |
| Date of First Compliant Deposit: | 8 June 2026 |
| Last Modified: | 08 Jun 2026 09:15 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/187331 |
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