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Ex-vivo biomechanical evaluation of flap and residual stroma biomechanical properties following high-irradiance CXL combined with Myopic LASIK

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Session Details

Session Title: Cornea
Session Date/Time: Sunday 28/02/2016 | 08:30-11:00
Paper Time: 09:30
Venue: MC2 Room
First Author: : C.Karabatsas GREECE
Co Author(s): :    A. Kanellopoulos   G. Asimellis           

Abstract Details


To evaluate ex vivo biomechanical and enzymatic digestion resistance differences between standard myopic LASIK compared to LASIK+CXL, in which high-irradiance cross-linking (CXL) is added.

Setting: Clinical and Research Eye Institute, Athens, Greece


Eight human donor corneas were subjected to femtosecond-assisted myopic LASIK. Group-A (n=4) served as a control group (no CXL). The corneas in LASIK+CXL group-B were subjected to concurrent prophylactic high-irradiance CXL (n=4). Saline-diluted (0.10%) riboflavin was instilled on the stroma, subsequently irradiated with UV-A through the repositioned flap. The cornea stroma and flap specimens were separately subjected to transverse biaxial resistance measurements; biomechanical differences were assessed via stress and Young’s shear modulus. Subsequently, the specimens were subjected to enzymatic digestion resistance tests (Collagenase digestion).


For the corneal stroma specimen, stress at the 10% strain was 128±11 kPa for the control group-A vs 293±20 kPa for the LASIK+CXL group-B (relative difference Δ=+129%, p<0.05). The stress in group-B was also increased at the 20% strain by +68% (p<0.05). Shear modulus in group-B was increased at the 10% strain by +79%, and at the 20% strain by +48% (both statistically significant, p<0.05). The enzymatic degradation time to dissolution was in group-A 157.5±15.0 min versus 186.25±7.5 min in group-B (Δ=+18%, p=0.014).


LASIK+CXL appears to provide significant increase in underlying corneal stromal rigidity, up to +130%. Additionally, there is significant relevant enzymatic digestion resistance confirmatory to the above. LASIK flaps appear unaffected biomechanically by the LASIK+CXL procedure, suggesting effective CXL just under the flap.

Financial Disclosure:

One or more of the authors travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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