PurposeSecond harmonic generation signals (SHG) are emitted preferentially from collagenous tissue structures and have been used to evaluate photochemically-induced (CXL) crosslinking changes in the cornea. Since therapeutic tissue crosslinking (TXL) using sodium hydroxymethylglycinate (SMG) of the sclera is a potential treatment for high myopia, we explored the use of SHG microscopy to evaluate the effects.MethodsSingle sub-Tenon's (sT) injections (400 μL) using SMG (40–400 mM) were made at the equatorial 12 o'clock position of the right eye of cadaveric rabbit heads (n = 16 pairs). After 3.5 hours, confocal microscopy (CM) was performed using 860 nm two-photon excitation and 400 to 450 nm emission. Pixel density and fiber bundle “waviness” analyses were performed on the images. Crosslinking effects were confirmed using thermal denaturation (Tm) temperature. Comparison experiments with riboflavin photochemical crosslinking were done.ResultsTherapeutic tissue crosslinking localization studies indicated that crosslinking changes occurred at the site of injection and in adjacent sectors. Second harmonic generation signals revealed large fibrous collagenous bundled structures that displayed various degrees of waviness. Histogram analysis showed a nearly 6-fold signal increase in 400 mM SMG over 40 mM. This corresponded to a ΔTm = 13°C for 400 mM versus ΔTm = 4°C for 40 mM. Waviness analysis indicated increased fiber straightening as a result of SMG CXL.ConclusionsSecond harmonic generation signal intensity and fiber bundle waviness is altered by scleral tissue crosslinking using SMG. These changes provide insights into the macromolecular changes that are induced by therapeutic crosslinking technology and may provide a method to evaluate connective tissue protein changes induced by scleral crosslinking therapies.

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Aims Bioprosthetic heart valves (BHV), made from glutaraldehyde-fixed heterograft materials, are subject to more rapid structural valve degeneration (SVD) in pediatric and young adult patients. Differences in blood biochemistries and propensity for disease accelerate SVD in these patients, which results in multiple re-operations with compounding risks. The goal of this study is to investigate the mechanisms of BHV biomaterial degeneration and present models for studying SVD in young patients and juvenile animal models. Methods and Results We studied SVD in clinical BHV explants from pediatric and young adult patients, juvenile sheep implantation model, rat subcutaneous implants, and an ex vivo serum incubation model. BHV biomaterials were analyzed for calcification, collagen microstructure (alignment and crimp), and crosslinking density. Serum markers of calcification and tissue crosslinking were compared between young and adult subjects. We demonstrated that immature subjects were more susceptible to calcification, microstructural changes, and advanced glycation end products formation. In vivo and ex vivo studies comparing immature and mature subjects mirrored SVD in clinical observations. The interaction between host serum and BHV biomaterials leads to significant structural and biochemical changes which impact their functions. Conclusions There is an increased risk for accelerated SVD in younger subjects, both experimental animals and patients. Increased calcification, altered collagen microstructure with loss of alignment and increased crimp periods, and increased crosslinking are three main characteristics in BHV explants from young subjects leading to SVD. Together, our studies establish a basis for assessing the increased susceptibility of BHV biomaterials to accelerated SVD in young patients. Translational Perspective Bioprosthetic heart valves (BHV) are the predominant treatment option for valvular heart diseases. However, the main drawback of BHV is their limited durability. Although it has been widely acknowledged that young patients are more susceptible to BHV degeneration and have shorter implant durations, the underlying mechanisms remain elusive. We examined the BHV degeneration process in clinical BHV explants from young and older patients, juvenile sheep implantation model, rat subcutaneous implant model, and ex vivo serum incubation model. These comprehensive basic to translational studies highlighted that BHV degeneration is significantly associated with age related risk factors. These studies also shed light on understanding the degeneration of a variety of xenografts and lay the foundation for future studies on mitigating device degeneration in young patients.

Background While each scleral fixation method has its own advantages, there is a lack of strong evidence to suggest a superior technique. Advances in cataract surgery expand patient eligibility for successful cataract extraction, benefitting a growing population of pseudophakic patients. However, implantation of secondary intraocular lens (IOL) with compromised anterior or posterior capsule is a more challenging task. Each method of scleral fixation has its own advantages and none of them has strong evidence to be superior. This paper describes postsurgical outcomes of two scleral intraocular(IOL) fixation techniques combined with pars plana vitrectomy(PPV) from a single tertiary referral eye center. Methods Patients underwent PPV and IOL implantation with either four-point sutured scleral fixation (Akreos AO60(AK); n = 24) or two-point sutureless flanged intrascleral fixation (CT Lucia(CTL); n = 7). Reports include IOL and sclerotomy placement, fixation techniques, and IOL model. Results Thirty-one eyes of thirty patients were analyzed. Average change in vision from baseline measurement was LogMAR − 0.68 ± 0.66 and − 0.90 ± 0.63 for AK and CTL groups, respectively. Average postoperative refractive error was − 0.3 ± 1.03 D (AK) and 0.4 ± 0.60 D (CTL). No opacification cases of Akreos lens were found in this study with the longest follow up of 53 months. Conclusions Both methods of implantation (sutured and sutureless) could provide good visual and refractive outcomes. Minimal complication rates were reported despite including patients with multiple comorbidities, making both techniques an attractive choice for secondary IOL implantation.

Purpose To develop methods to delineate the relationship between endothelial cell toxicity and tissue fixation (toxicity/fixation) using sodium hydroxymethylglycinate (SMG), a formaldehyde releaser, and riboflavin-UVA (CXL) for therapeutic tissue cross-linking of the cornea. Methods Eleven (11) fresh cadaveric rabbit heads were used for ex vivo corneal cross-linking simulation. Following epithelial debridement, the tissue was exposed to 1/4 Max (9.765mM) or 1/3Max (13.02mM) SMG at pH 8.5 for 30min or riboflavin-UVA (CXL). The contralateral cornea served as a paired control. Post-exposure, cross-linking efficacy was determined by thermal denaturation temperature (Tm) and endothelial damage was assessed using calcein AM and ethidium homodimer staining (Live/Dead Kit). Confocal laser scanning fluorescence microscopy was used to generate live/dead cell counts following a standardized algorithm. Results The ΔTm following CXL, 1/3 SMG, and 1/4 SMG was 2.19±0.91°C, 1.33±0.49 °C, and 1.10 ±0.46 °C, respectively. Endothelial cell damage was expressed as the percent of dead cells/live + dead cells counted per high powered field. The values were 2.95±1.74% (control) and 8.86±11.10% (CXL) [p=0.390]; 0.98±0.20% (control) and 19.53±32.22% (1/3max SMG) [p=0.426]; and 2.70±2.37% (control) and 2.84±2.24% (1/4 max SMG) [p=0.938];. The values for endothelial toxicity were then indexed over the shift in Tm in order to yield a toxicity/fixation index. The values were as follows: 2.70 for CXL, 13.95 for 1/3 max, and 0.13 for 1/4 max. Conclusions Quarter max (1/4 Max = 9.765mM) SMG effectively cross-linked tissue and was non-toxic to endothelial cells. Thus, SMG is potentially a compound that could achieve both desired effects.