Cruzat Andrea, Shukla Anita N, Arafat Samer N, Alageel Saleh, Colon Clara, Chodosh James, Ciolino Joseph B
J Refract Surg. 2017 Mar 1;33(3):171-177. doi: 10.3928/1081597X-20161206-04.
To perform in vitro assessment of different techniques of transepithelial corneal cross-linking (CXL) and to compare the results to deepithelialized CXL.
Transepithelial CXL was performed after pre-treatment with or without penetration enhancers (gum cellulose, 0.44% sodium chloride, and 0.01% benzalkonium chloride) for 15 or 60 minutes. Deepithelialized corneas underwent CXL after pretreatment with riboflavin for 15 minutes, according to the Dresden protocol. All corneas were incubated in 0.3% collagenase A solution and the time to total dissolution was measured. Corneas were also imaged with confocal microscopy to evaluate the corneal epithelium, subbasal nerve plexus, and depth of stromal keratocyte nuclei as a means of measuring the depth of collagen CXL.
Deepithelialized CXL corneas with 15 minutes of pretreatment dissolved after 15.4 ± 3.1 hours, significantly longer (P = .001) than deepithelialized untreated corneas (8.5 ± 0.6 hours). Transepithelial CXL corneas with 15 minutes of pretreatment with or without penetration enhancers dissolved after 8.3 ± 2.1 and 7.4 ± 1.6 hours, respectively. A longer pretreatment of 60 minutes with penetration enhancers resulted in greater resistance to degradation of the transepithelial CXL corneas (14.6 ± 2.2 hours), which was similar to deepithelialized CXL corneas. The results of the biological assay correlated well with the imaging results obtained by confocal microscopy.
Corneas treated by transepithelial CXL with an extended pretreatment time of 60 minutes and penetration enhancers exhibited similar characteristics as corneas treated by the deepithelialized CXL approach. By confocal imaging, the transepithelial approach with extended pretreatment time demonstrated evidence of epithelial damage, which may have improved the treatment effect of this group. [J Refract Surg. 2017;33(3):171-177.].
对不同的经上皮角膜交联（CXL）技术进行体外评估，并将结果与去上皮CXL进行比较。
在使用或不使用渗透促进剂（胶质纤维素、0.44%氯化钠和0.01%苯扎氯铵）预处理15或60分钟后进行经上皮CXL。根据德累斯顿方案，去上皮角膜在使用核黄素预处理15分钟后进行CXL。将所有角膜置于0.3%胶原酶A溶液中，测量完全溶解所需的时间。还使用共聚焦显微镜对角膜进行成像，以评估角膜上皮、基底膜下神经丛和基质角膜细胞核的深度，作为测量胶原CXL深度的一种方法。
预处理15分钟的去上皮CXL角膜在15.4±3.1小时后溶解，明显长于未处理的去上皮角膜（8.5±0.6小时，P = 0.001）。使用或不使用渗透促进剂预处理15分钟的经上皮CXL角膜分别在8.3±2.1和7.4±1.6小时后溶解。使用渗透促进剂进行60分钟的较长预处理导致经上皮CXL角膜的抗降解能力增强（14.6±2.2小时），这与去上皮CXL角膜相似。生物学检测结果与共聚焦显微镜获得的成像结果相关性良好。
经上皮CXL且预处理时间延长至60分钟并使用渗透促进剂处理的角膜表现出与去上皮CXL方法处理的角膜相似的特征。通过共聚焦成像，预处理时间延长的经上皮方法显示出上皮损伤的证据，这可能改善了该组的治疗效果。[《屈光手术杂志》。2017；33(3):171 - 177。]
