A comparison study of Riboflavin/UV-A and Rose-Bengal/Green light cross-linking of the rabbit corneas using optical coherence elastography

The biomechanical properties of the cornea are critical factors which determine its health and subsequent visual acuity. Keratoconus is a structural degeneration of the cornea which can diminish vision quality. Riboflavin/UV-A corneal collagen cross-linking (UV-CXL) is an emerging treatment that increases the stiffness of the cornea and improves its ability to resist further degeneration. While UV-CXL has shown great promise for effective therapy of the keratoconus, there are concerns associated with the UV irradiation, such as keratocyte cytotoxicity. Rose-bengal/green light corneal collagen cross-linking (RGX) has been proposed as an alternative to UV-CXL. Because of the high absorbance of the rose-bengal dye at green wavelengths, the treatment time is significantly shorter than with UV-CXL. Moreover, because green light is used in lieu of UV irradiation, there are no cytotoxic side-effects. In this study, noncontact optical coherence elastography (OCE) was used to compare the outcomes of UV-CXL and RGX treatment in rabbit cornea. Low-amplitude (micrometer scale) elastic waves were induced by a focused air-pulse loading system. The elastic wave propagation was then imaged by a phase-stabilized swept source OCE (PhS-SSOCE) system. The changes in the viscoelasticity of the corneas were quantified by a previously developed modified Rayleigh Lamb frequency model. The depth-resolved micro-scale phase-velocity distribution in the cornea was used to reveal the depth-wise heterogeneity before and after both cross-linking techniques. Our results show that UV-CXL and RGX increased the stiffness of the corneas by ∼54% and ∼5% while reducing the viscosity by ∼42% and ∼17%, respectively. The depth-wise phase velocities showed that UV-CXL affected the anterior ∼1/3 of the corneas, while RGX only affected the anterior ∼1/7 of the corneas.