Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

An investigation into corneal enzymatic resistance following epithelium-off and epithelium-on corneal cross-linking protocols

Aldahlawi, Nada Hussein, Hayes, Sally ORCID:, O'Brart, David P.S., O'Brart, Naomi and Meek, Keith Michael Andrew ORCID: 2016. An investigation into corneal enzymatic resistance following epithelium-off and epithelium-on corneal cross-linking protocols. Experimental Eye Research 153 , pp. 141-151. 10.1016/j.exer.2016.10.014

[thumbnail of aldahlawi_published_openaccess.pdf]
PDF - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview


The aim of this study was to investigate corneal enzymatic resistance following epithelium off and on riboflavin/UVA cross-linking (CXL). One hundred and fourteen porcine eyes were divided into four non-irradiated control groups and seven CXL groups. The latter comprised; (i) epithelium-off, 0.1% iso-osmolar riboflavin, 9 mW UVA irradiation for 10 min, (ii) disrupted epithelium, 0.1% hypo-osmolar riboflavin, 9 mW UVA for 10 min, (iii) epithelium-on, 0.25% hypo-osmolar riboflavin with 0.01% benzylalkonium chloride (BACS), 9 mW UVA for 10 min, (iv) epithelium-on, 5 min iontophoresis at 0.1 mA for 5 min with 0.1% riboflavin solution, 9 mW UVA for 10 min or (v) 12.5 min, (vi) epithelium-on, prolonged iontophoresis protocol of 25 min with 1.0 mA for 5 min and 0.5 mA for 5 min with 0.25% riboflavin with 0.01% BACS, 9 mW UVA for 10 min or (vii) 12.5 min. Enzymatic resistance was assessed by daily measurement of a corneal button placed in pepsin solution and measurement of corneal button dry weight after 11 days of digestion. This study revealed that the enzymatic resistance was greater in CXL corneas than non-irradiated corneas (p < 0.0001). Epithelium-off CXL showed the greatest enzymatic resistance (p < 0.0001). The prolonged iontophoresis protocol was found to be superior to all other trans-epithelial protocols (p < 0.0001). A 25% increase in UVA radiance significantly increased corneal enzymatic resistance (p < 0.0001). In conclusion, although epithelium-on CXL appears to be inferior to epithelium-off CXL in terms of enzymatic resistance to pepsin digestion, the outcome of epithelium-on CXL may be significantly improved through the use of higher concentrations of riboflavin solution, a longer duration of iontophoresis and an increase in UVA radiance.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Optometry and Vision Sciences
Uncontrolled Keywords: Keratoconus; Cornea; Cross-linking; Epithelium-off; Epithelium-on; CXL; Enzymatic digestion
Publisher: Elsevier
ISSN: 0014-4835
Funders: MRC
Date of First Compliant Deposit: 1 November 2016
Date of Acceptance: 14 October 2016
Last Modified: 06 May 2023 19:31

Citation Data

Cited 26 times in Scopus. View in Scopus. Powered By Scopus® Data

Actions (repository staff only)

Edit Item Edit Item


Downloads per month over past year

View more statistics