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

This study evaluated whether an oxygen-supplemented accelerated scleral collagen cross-linking protocol can provide durable biomechanical reinforcement and myopia-control efficacy comparable to the traditional (long) protocol, without compromising ocular safety. Young New Zealand White rabbits underwent unilateral riboflavin–UVA scleral cross-linking in the superonasal quadrant (right eye), with the contralateral eye serving as an intraindividual control. The accelerated protocol used high irradiance (30 mW/cm² for 3 minutes) with 90% oxygen supplementation, while the traditional protocol used 3 mW/cm² for 30 minutes under normoxia. Efficacy endpoints included spherical equivalent refraction (SER), axial length (AL), and scleral mechanical stiffness (tangent modulus) measured at 1 and 3 months; safety endpoints included electroretinography (ERG) and histology (H&E staining) of posterior ocular tissues. Over a 3-month follow-up, oxygen-supplemented accelerated cross-linking significantly preserved refractive power and inhibited axial elongation relative to contralateral controls, with no statistically significant differences versus the traditional protocol at matched time points. Biomechanically, scleral tangent modulus increased significantly at 1 and 3 months after surgery, and the magnitude of stiffening was comparable between accelerated+oxygen and traditional protocols. ERG and histology showed no evidence of retinal functional impairment or posterior tissue damage in either treatment group. Overall, the data support oxygen-supplemented accelerated scleral cross-linking as a faster alternative that maintains efficacy and biomechanical reinforcement with an acceptable short-term safety profile in vivo.