Collagen crosslinking of human and porcine sclera.

PURPOSE: To develop methods of collagen crosslinking the sclera to increase its biomechanical strength for the treatment of progressive myopia.
SETTING: Department of Ophthalmology, Technical University of Dresden, Dresden, Germany.
METHODS: Sagitally oriented scleral strips of 4.0 mm x 8.0 mm were prepared from 5 human postmortem eyes and 50 porcine cadaver eyes and treated with various crosslinking methods including physical crosslinking by combined riboflavin-ultraviolet A (UVA) or rose bengal/white-light irradiation and chemical crosslinking by incubation with glucose, ribose, glyceraldehyde, and glutaraldehyde solutions. Parallel scleral strips from the same eye were used as untreated controls. After crosslinking, stress-strain measurements of the treated and control scleras were performed using a microcomputer-controlled biomaterial tester.
RESULTS: A statistically significant increase in scleral rigidity was found after crosslinking with riboflavin-UVA, with a rise in stress in treated porcine (157%) and human (29%) sclera, and after treatment with glyceraldehyde, with a rise in stress in treated porcine (487%) and human (34%) sclera, and with glutaraldehyde, with a rise in stress in treated porcine (817%) and human sclera (122%) at 8% strain. The other crosslinking methods proved ineffective. The untreated human sclera had a 4-fold higher stiffness than porcine sclera.
CONCLUSIONS: Collagen crosslinking induced by riboflavin-UVA, glyceraldehyde, and glutaraldehyde led to a significant increase in biomechanical strength in human and porcine sclera. Using these methods, collagen crosslinking might become a treatment possibility for progressive myopia. Future animal and clinical studies must determine the best application methods and the long-term effects of increased crosslinking on scleral rigidity and prevent potential toxicity or serious side effects.