Biological and biomechanical responses to traditional epithelium-off and transepithelial riboflavin-UVA CXL techniques in rabbits.
Biological and biomechanical responses to traditional epithelium-off and transepithelial riboflavin-UVA CXL techniques in rabbits.
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DOI：
10.3928/1081597x-20130415-04
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发表时间：
2013-05
期刊：
影响因子：
--
通讯作者：
Wilson SE
中科院分区：
文献类型：
--
作者：
Armstrong BK;Lin MP;Ford MR;Santhiago MR;Singh V;Grossman GH;Agrawal V;Sinha RA;Butler RS;Dupps WJ;Wilson SE
比较核黄素-紫外线A （UVA）角膜交联（CXL）在兔模型上的生物学效应，采用传统的脱上皮法和几种经上皮法。同时进行了生物力学刚度的初步实验。四个治疗组包括：(1)标准上皮脱落，(2)丁卡因转上皮，(3)苯扎氯铵-乙二胺四乙酸（BKC-EDTA）转上皮，(4)飞秒激光辅助转上皮核黄素- uva CXL。分别于治疗后24小时和2个月对治疗组和对照组各6只眼进行伤口愈合研究。TUNEL法检测基质细胞死亡程度。光密度用Scheimpflug分析仪测定。治疗2个月后，采用光学相干弹性成像技术对每组3只眼的角膜硬化效果进行定量分析。在CXL后24小时，基质细胞死亡延长了标准脱上皮CXL和飞秒激光辅助CXL的角膜厚度，但仅延长了BKC-EDTA经上皮CXL后角膜厚度的约三分之一。丁卡因经上皮细胞CXL检测基质细胞死亡可忽略不计。BKC-EDTA经上皮CXL组与标准上皮脱落CXL组细胞死亡结果差异有统计学意义（P < 0.0001）。角膜混浊差异显著。治疗后与对照组相比，标准上皮细胞密度最大，丁卡因经上皮细胞密度最小。通过光学相干弹性成像测量，BKC-EDTA经上皮CXL比脱上皮CXL、飞秒激光辅助CXL或丁卡因经上皮CXL有更大的平均硬化趋势，但结果没有达到统计学意义。与对照组相比，所有CXL治疗组均表现出明显较小的刚度方差。在兔模型中，BKC-EDTA经上皮CXL比标准上皮脱落CXL或飞秒激光辅助CXL产生更少的间质细胞死亡和内皮细胞损伤风险。需要进一步的研究来确定非上皮性CXL组和经上皮性CXL组之间的生物力学刚度是否有显著差异。
To compare the biological effects of riboflavin-ultraviolet A (UVA) corneal cross-linking (CXL) performed with a traditional epithelium-off method to several transepithelial methods in a rabbit model. Preliminary experiments on biomechanical rigidity were also performed. Four treatment groups were included: (1) standard epithelium-off, (2) tetracaine transepithelial, (3) benzalkonium chloride-ethylenediaminetetraacetic acid (BKC-EDTA) transepithelial, and (4) femtosecond laser-assisted transepithelial riboflavin-UVA CXL. Six eyes from each treatment group and the untreated control group were analyzed at 24 hours and 2 months after treatment in wound healing studies. The TUNEL assay was performed to detect the extent of stromal cell death. Optical density was measured with a Scheimpflug analyzer. The corneal stiffening effect was quantitated in three eyes from each group using optical coherence elastography performed 2 months after treatments. Twenty-four hours after CXL, stromal cell death extended full corneal thickness with both standard epithelium-off CXL and femtosecond laser-assisted CXL, but only approximately one-third stromal depth after BKC-EDTA transepithelial CXL. Negligible stromal cell death was detected with tetracaine transepithelial CXL. Cell death results were statistically different between the BKC-EDTA transepithelial CXL and standard epithelium-off CXL groups (P < .0001). Significant corneal opacity differences were noted. Standard epithelium-off CXL had the greatest density and tetracaine transepithelial CXL had the least density compared to the control group after treatment. As measured with optical coherence elastography, a trend toward greater mean stiffening was observed with BKC-EDTA transepithelial CXL than with epithelium-off CXL, femtosecond laser-assisted CXL, or tetracaine transepithelial CXL, but the result did not reach statistical significance. All of the CXL treatment groups exhibited significantly smaller variance of stiffness compared to the control group. In the rabbit model, BKC-EDTA transepithelial CXL produced less stromal cell death and less risk of endothelial cell damage than standard epithelium-off CXL or femtosecond laser-assisted CXL. Additional study is needed to determine whether biomechanical stiffness is significantly different between the epithelium-off CXL and transepithelial CXL groups.