Changes in Corneal Biomechanical Properties in PRK Followed by Two Accelerated CXL Energy Doses in Rabbit Eyes

PURPOSE: To evaluate whether photorefractive keratectomy (PRK) combined with the two commonly delivered energy doses in accelerated corneal cross-linking (A-CXL) could help the cornea maintain its preoperative stiffness level. METHODS: A total of 72 corneas of 36 healthy white Japanese rabbits were randomly divided into four equal groups. The groups included an untreated control group and three that had undergone PRK. After tissue ablation, one of the latter three groups (PRK group) was left untreated, whereas the other two were exposed to riboflavin (0.22% concentration by volume) and ultraviolet-A (370 nm) with the same irradiation (30 mW/cm 2 ) but different CXL energy doses of 1.8 J/cm 2 (PXL group) and 2.7 J/cm 2 (PXH group). Dynamic Scheimpflug analyzer (Corvis ST; Oculus Optikgeräte GmbH) measurements of stiffness parameter at first applanation (SP-A1), Stress-Strain Index (SSI), and other dynamic corneal response parameters were taken 3 days preoperatively and 1 month postoperatively. Subsequently, ex vivo inflation testing was performed and the tangent modulus of each specimen was estimated using an inverse analysis process. RESULTS: In comparison to the control group, the tangent modulus at a stress of 10 kPa decreased by 8.9% in the PRK group and increased by 10.6% and 22.4% in the PXL and PXH groups, respectively. SP-A1 decreased postoperatively in the PRK group ( P < .05), indicating an overall stiffness reduction of −7.4, −3.5, and −5.3 mm Hg/mm in PRK, PXL, and PXH groups, respectively. The material stiffness parameter SSI remained almost unchanged in the PRK group ( P = .989), increased slightly in the PXL group (8.3%, P = .077), and increased significantly in the PXH group (11.1%) ( P < .05). CONCLUSIONS: Biomechanical deterioration following PRK was significant and could not be fully compensated for by ACXL with either 1.8 or 2.7 J/cm 2 doses. The increased value of corneal overall stiffness was higher in A-CXL with 2.7 J/cm 2 energy than with 1.8 J/cm 2 energy. [ J Refract Surg . 2021;37(12):853–860.]