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. 2025 Jun 2;66(6):10.
doi: 10.1167/iovs.66.6.10.

The Efficiency and Safety of Oxygen-Supplemented Accelerated Scleral Cross-Linking in Rabbits

Lingling Yan  1 , Ce Wu  1 , Xiaona Liu  1 , Pengfei Han  2 , Jie Zhang  1 , Zhipeng Gao  1 , Xiaona Li  1 , Weiyi Chen  1
Affiliations

The Efficiency and Safety of Oxygen-Supplemented Accelerated Scleral Cross-Linking in Rabbits

Lingling Yan et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: The purpose of this study was to evaluate the efficacy and safety of accelerated scleral collagen cross-linking (SXL) with supplemental oxygen.

Methods: The rabbit scleral tissues were randomly divided into seven different SXL protocols, including traditional (T)-SXL (3 mW/cm2 for 30 minutes, 3*30) and accelerated (A)-SXL (30 mW/cm2 for 3, 5, or 8 minutes, respectively, with or without supplemental oxygen). The control group received no ultraviolet-A (UVA) radiation. The tangent modulus of scleral strip was determined by uniaxial tensile test. The protocol with better mechanical property and shorter cross-linking time in vitro was selected for immediate safety assessment using electroretinogram (ERG) in vivo, hematoxylin and eosin (H&E) staining and TUNEL assay in vitro.

Results: The tangent modulus was significantly greater in all SXL groups compared to the control group. The equatorial sclera showed a larger stiffening effect than the posterior. In the equatorial sclera, extending the irradiation time in normoxic A-SXL can result in a further enhancement of the stiffening effect. The tangent modulus was enhanced by 92% in the hyperoxic A-SXL group (30*3) compared with the normoxic A-SXL (30*3) group, and achieved the same mechanical performance as the T-SXL group. The oxygen supplementation did not play a role in further improving he stiffening effect at the posterior sclera. The ERG and H&E staining indicated no abnormalities in the sclera and retina. Apoptosis was only observed in the outer layer of the sclera in the A-SXL groups.

Conclusions: A-SXL protocol of 30 mW/cm2 can improve the mechanical properties of the sclera. In particular, the protocol of 30 mW/cm2 for 3 minutes with supplemental oxygen showed excellent cross-linking efficacy with shorter surgical time and was relatively safe.

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Conflict of interest statement

Disclosure: L. Yan, None; C. Wu, None; X. Liu, None; P. Han, None; J. Zhang, None; Z. Gao, None; X. Li, None; W. Chen, None

Figures

Figure 1.
Figure 1.
The process of SXL. (a) Specimen strips from the equatorial and posterior sclera in vitro. (b) UVA irradiation with supplementary oxygen in vitro. (c) Crosslinking area in vivo. (d) Schematic of A-SXL design in vivo. The unilateral eye receives A-SXL with 21% oxygen in one group (left, n = 4), and with 90% oxygen in the other group (right, n = 4), respectively. Both contralateral eyes serve as the control. (e) The environment oxygen concentration of normoxic and hyperoxic conditions. Figures 1a to d were created with Figdraw.com.
Figure 2.
Figure 2.
(a) Stress-strain curves and (b) tangent modulus for control and cross-linked specimens in the equatorial sclera.
Figure 3.
Figure 3.
(a) Stress-strain curves and (b) tangent modulus for control and cross-linked specimens in the posterior sclera.
Figure 4.
Figure 4.
H&E staining. Retinal/scleral H&E staining results of control group and A-SXL groups in the (a) equatorial and (b) posterior sclera.
Figure 5.
Figure 5.
TUNEL staining. (a) Retinal and (b) scleral TUNEL staining in the equatorial area. (c) Retinal and (d) scleral TUNEL staining in the posterior area.
See this image and copyright information in PMC

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