Selective Equatorial Sclera Crosslinking in the Orbit Using a Metal-Coated Polymer Waveguide.

Kwok, Sheldon J J; Forward, Sarah; Wertheimer, Christian M; Liapis, Andreas C; Lin, Harvey H; Kim, Moonseok; Seiler, Theo G.; Birngruber, Reginald; Kochevar, Irene E; Seiler, Theo; Yun, Seok-Hyun (2019). Selective Equatorial Sclera Crosslinking in the Orbit Using a Metal-Coated Polymer Waveguide. Investigative ophthalmology & visual science, 60(7), pp. 2563-2570. Association for Research in Vision and Ophthalmology 10.1167/iovs.19-26709

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Purpose Photochemical crosslinking of the sclera is an emerging technique that may prevent excessive eye elongation in pathologic myopia by stiffening the scleral tissue. To overcome the challenge of uniform light delivery in an anatomically restricted space, we previously introduced the use of flexible polymer waveguides. We presently demonstrate advanced waveguides that are optimized to deliver light selectively to equatorial sclera in the intact orbit. Methods Our waveguides consist of a polydimethylsiloxane cladding and a polyurethane core, coupled to an optical fiber. A reflective silver coating deposited on the top and side surfaces of the waveguide prevents light leakage to nontarget, periorbital tissue. Postmortem rabbits were used to test the feasibility of in situ equatorial sclera crosslinking. Tensometry measurements were performed on ex vivo rabbit eyes to confirm a biomechanical stiffening effect. Results Metal-coated waveguides enabled efficient light delivery to the entire circumference of the equatorial sclera with minimal light leakage to the periorbital tissues. Blue light was delivered to the intact orbit with a coefficient of variation in intensity of 22%, resulting in a 45 ± 11% bleaching of riboflavin fluorescence. A 2-fold increase in the Young's modulus at 5% strain (increase of 92% P < 0.05, at 25 J/cm2) was achieved for ex vivo crosslinked eyes. Conclusions Flexible polymer waveguides with reflective, biocompatible surfaces are useful for sclera crosslinking to achieve targeted light delivery. We anticipate that our demonstrated procedure will be applicable to sclera crosslinking in live animal models and, potentially, humans in vivo.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ophthalmology

UniBE Contributor:

Seiler, Günter Theodor Michael


600 Technology > 610 Medicine & health




Association for Research in Vision and Ophthalmology




Günter Theodor Michael Seiler

Date Deposited:

07 Aug 2019 14:19

Last Modified:

22 Oct 2019 19:51

Publisher DOI:


PubMed ID:





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