In Vivo Evaluation of Efficacy and Safety of Oxygen-Supplemented Accelerated Scleral Cross-Linking Over Time in Young Rabbits

Purpose: To evaluate the efficacy and safety of riboflavin-ultraviolet A scleral cross-linking surgery over time in vivo using an accelerated protocol with supplemental oxygen. Methods: This study compared accelerated scleral collagen cross-linking (A-SXL) plus 90% O2 (30 mW/cm2 for 3 minutes with 90% oxygen supplementation) to the traditional protocol (T-SXL; 3 mW/cm2 for 30 minutes) in young New Zealand White rabbits. The right eye underwent surgery, and the left eye served as an intraindividual control. At different time points, efficiency was evaluated through spherical equivalent refraction (SER), axial length (AL), and scleral tangent modulus, and safety was assessed via electroretinogram (ERG) and hematoxylin and eosin (H&E) staining. Results: The A-SXL+90% O2 protocol significantly preserved refractive power and inhibited axial elongation over the 3-month postoperative period, and no statistically significant differences were detected when compared with the T-SXL group (P > 0.05). Moreover, the A-SXL+90% O2 protocol led to a significant increase in scleral tangent modulus at both 1 month and 3 months post-surgery, similar to the outcomes seen with T-SXL. ERG and H&E staining revealed no evidence of retinal functional impairment or histological alterations in posterior ocular tissues (sclera, choroid, and retina) in both scleral cross-linking protocols. Conclusions: A-SXL supplemented with oxygen offers a faster, effective, and relatively safe alternative to T-SXL in vivo by demonstrating sustained biomechanical reinforcement with an acceptable safety profile. Translational Relevance: A-SXL supplemented with oxygen may be a promising therapeutic approach for scleral weakening disorders such as progressive high myopia.