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Assessment of efficacy of a novel cross-linking protocol with intracameral oxygen injection (Bubble-CXL) in reducing the corneal elasticity using atomic force microscopy

Poster Details

First Author: A.Alkhalde AUSTRIA

Co Author(s):    H. Seferovic   P. Hinterdorfer   Y. Jin Oh   A. Simbrunner   A. Abri        

Abstract Details


To evaluate the efficacy of additionally intracameral oxygen injection in improving the corneal stiffness compared to standard crosslinking protocol. To our knowledge the bubble crosslinking protocol has not been described yet.


Corneal crosslinking is a proven therapy in preventing the progression of corneal ectasia. In addition to the standard Dresden protocol, a number of other Protocols have been developed. Enrichment of environmental oxygen has been shown to enhance the efficacy of conventional Crosslinking with respect to reduction of corneal elasticity.


Six fresh porcine eye pairs were included in this study. One eye of each pair was treated with the standard Dresden crosslinking protocol while in the partner eye intracameral oxygen was injected prior to conventional crosslinking. At the end of procedure the oxygen bubble was removed. A 6 mm central corneal disc was cut using a corneal vacuum trephine. The corneal tissue was fixed with a glue on a glass plate and stored in NaCl 0,9 % solution at a temperature of 4 ° C. The next day corneal elasticity was measured using the atomic force microscope.


Three eye pairs were excluded because of the bad quality of measurement or corneal oedema. In all three analysed eye pairs the elasticity modulus in the eyes treated with intracameral oxygen was higher compared to the eyes treated with the standard protocol alone. The difference was respectively 37,67 (72,6%), 134.04 (202.2%) and 28,29 (29,8%) kPa.


Our results show that adjunctive use of intracameral oxygen may lead to a further improvement of biomechanical corneal properties after crosslinking therapy in porcine eyes. Other studies are needed to prove the efficacy and safety of this new bubble crosslinking protocol in human eyes with corneal ectasia.

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