Citation: Søndergaard AP, Ivarsen A, Hjortdal J. Corneal resistance to shear force after UVA-riboflavin cross-linking. Invest Ophthalmol Vis Sci. 2013;54:5059-5069. DOI:10.1167/ iovs.12-10710 PURPOSE. We evaluated whether UVA-riboflavin collagen cross-linking (CXL) increases transverse stromal shear moduli ex vivo, whether the shear moduli are greater in the anterior compared to the posterior stroma, and whether the shear moduli are affected by CXL.METHODS. The resistance to unidirectional transverse shear of human (n ¼ 18) and porcine (n ¼ 42) corneas was measured in a custom engineered biaxial biomechanical setup at different hydrations. The corneas were separated into untreated, riboflavin solution-treated, and CXLtreated groups. The depth dependency of shear moduli within groups was assessed in femtosecond laser cut sheets. Dry weights were obtained for solids correction.
RESULTS.In porcine full-thickness buttons and 300 lm anterior sheets, a significantly increased unidirectional transverse shear modulus was detected in riboflavin-treated and CXL-treated groups compared to the respective untreated groups. There was no significant difference in shear modulus between riboflavin-and CXL-treated groups. In all groups, the shear moduli were greater in the anterior sheets compared to posterior sheets. Similar results were detected in human corneas.
CONCLUSIONS.A method for unidirectional transverse shear resistance measurement was developed. The shear moduli were greater in the anterior compared to the posterior sheets. Increase in shear moduli was observed in the riboflavin and CXL groups compared to the untreated group, indicating that the immediate effects of the riboflavin or CXL treatment may be due partly to ground substance/dextran-5-phosphate interaction.Keywords: cornea, riboflavin, UVA, cross-linking, CXL, collagen, swelling pressure, shear force, shear modulus, biomechanics T he corneal stroma is a very dense matrix composed of several hundred sheets of highly organized collagen lamellae, stacked on each other preferably in parallel with respect to the corneal surface. Within a given lamella, the majority of fibrils lie parallel to each other and to the corneal surface, but at large angles with those in adjacent lamella. Overall, they are found at all angles within the corneal plane. Anterior and midstromal lamellae bifurcate and interweave, 1 whereas posterior lamellae tend to lie noninterwoven in stacked layers.2 The collagen fibrils in the central cornea have preferred directions in the inferior-superior and nasal-temporal meridians in the posterior two-thirds, whereas the anterior third is arranged more isotropically. 3,4 This microstructure of the corneal stroma suggests that its elasticity will depend on direction during mechanical testing (anisotropy) and that the in-plane properties will be different from the transverse properties.5-7 The cornea shears readily in the tangential plane without separating, even at high shear deformations. 8,9 Thus, the stroma possesses self-cohesion between c...