Femtosecond laser technology is rapidly becoming a heavily utilized tool in corneal refractive surgical procedures due to its reproducibility, safety, precision, and versatility.

CXL seems to be effective and safe in halting progression of keratoconus over a long-term follow-up period up to 5 years postoperatively.

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No author has a financial or proprietary interest in any material or method mentioned.

With multiple adjuvant techniques, CXL plus is likely to benefit many patients with corneal ectatic disorders. The appropriate combined procedure will depend on multiple factors, such as refraction, corneal thickness, and degree of irregular astigmatism.

The purpose of this project was to assess anterior and posterior corneal stromal elasticity after corneal collagen cross linking (CXL) treatment in human cadaver eyes using Atomic Force Microscopy (AFM) through indentation. Twenty four human cadaver eyes (12 pairs) were included in this study and divided into 2 groups (6 pairs per group). In both groups, the left eye (OS) served as a control (no riboflavin or CXL treatment was performed) and the right eye (OD) underwent CXL treatment (30 minutes of riboflavin pretreatment followed by 30 minutes of exposure to 3mW/cm2 of ultraviolet light). In group 1, the anterior stroma was exposed by manual delamination of approximately 50μm of the corneal stroma including Bowman’s membrane. In group 2, the posterior stroma was exposed by delamination of the anterior 50% of the corneal stroma including Bowman’s membrane. Delamination was performed after crosslinking treatment in the case of the treated eyes. In all eyes, the stromal elasticity was quantified using AFM through indentation. Young’s modulus of elasticity for the anterior cornea (group 1) was 245.9±209.1kPa (range: 82.3 - 530.8 kPa) for the untreated control eyes, and 467.8±373.2kPa (range: 157.4 – 1126 kPa) for the CXL treated eyes. Young’s modulus for the posterior cornea (group 2) was 100.2±61.9kPa (range: 28.1 - 162.6 kPa) for the untreated control eyes and 66.0±31.8kPa (range: 31.3 - 101.7 kPa) for the CXL treated eyes. Young’s modulus of the anterior stroma significantly increased after CXL treatment (p=0.024), whereas the posterior stroma did not demonstrate a significant difference in Young’s modulus after CXL treatment (p=0.170). The anterior stroma was stiffer than the posterior stroma for both the control and CXL treatment groups (p=0.077 and p=0.023, respectively). Our findings demonstrate that stiffness of the anterior corneal stroma after CXL treatment seems to increase significantly, while the posterior stroma does not seem to be affected by CXL.

Mean depth of the corneal stromal demarcation line after CXL treatment is greater centrally in comparison with nasal and temporal depths.