The swelling pressure of the human corneal stroma as determined by a new method

An Overview of Advanced In Vitro Corneal Models: Implications for Pharmacological Testing

The cornea is an important barrier to consider when developing ophthalmic formulations, but proper modeling of this multilayered tissue remains a challenge. This is due to the varying properties associated with each layer in addition to the dynamics of the tear film. Hence, the most representative models to date rely on animals. Animal models, however, differ from humans in several aspects and are subject to ethical limitations. Consequently, in vitro approaches are being developed to address these issues. This review focuses on the barrier properties of the cornea and evaluates the most advanced three-dimensional cultures of human corneal equivalents in literature. Their application potential is subsequently assessed and discussed in the context of preclinical testing along with our perspective toward the future. Impact statement Most ocular drugs are applied topically, with the transcorneal pathway as the main administration route. Animal corneas are currently the only advanced models available, contributing to the drug attrition rate. Anatomical and physiological interspecies differences might account for a poor translatability of preclinical results to clinical trials, urging researchers to devise better corneal equivalents. This review elaborates on the emerging generation of three-dimensional in vitro models, which comprises spheroids, organoids, and organs-on-chips, which can serve as a stepping stone for advancements in this field.

Corneal xenotransplantation: Where are we standing?

The search for alternatives to allotransplants is driven by the shortage of corneal donors and is demanding because of the limitations of the alternatives. Indeed, current progress in genetically engineered (GE) pigs, the introduction of gene-editing technology by clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9, and advanced immunosuppressants have made xenotransplantation a possible option for a human trial. Porcine corneal xenotransplantation is considered applicable because the eye is regarded as an immune-privileged site. Furthermore, recent non-human primate studies have shown long-term survival of porcine xenotransplants in keratoplasty. Herein, corneal immune privilege is briefly introduced, and xenogeneic reactions are compared with allogeneic reactions in corneal transplantation. This review describes the current knowledge on special issues of xenotransplantation, xenogeneic rejection mechanisms, current immunosuppressive regimens of corneal xenotransplantation, preclinical efficacy and safety data of corneal xenotransplantation, and updates of the regulatory framework to conduct a clinical trial on corneal xenotransplantation. We also discuss barriers that might prevent xenotransplantation from becoming common practice, such as ethical dilemmas, public concerns on xenotransplantation, and the possible risk of xenozoonosis. Given that the legal definition of decellularized porcine cornea (DPC) lies somewhere between a medical device and a xenotransplant, the preclinical efficacy and clinical trial data using DPC are included. The review finally provides perspectives on the current standpoint of corneal xenotransplantation in the fields of regenerative medicine.

Cell Loaded GelMA:HEMA IPN hydrogels for corneal stroma engineering

Stroma is the main refractive element of the cornea and damage to it is one of the main causes of blindness. In this study, cell loaded hydrogels of methacrylated gelatin (GelMA) and poly(2-hydroxyethyl methacrylate) (pHEMA) (8:2) interpenetrating network (IPN) hydrogels were prepared as the corneal stroma substitute and tested in situ and in vitro. Compressive modulus of the GelMA hydrogels was significantly enhanced with the addition of pHEMA in the structure (6.53 vs 155.49 kPa, respectively). More than 90% of the stromal keratocytes were viable in the GelMA and GelMA-HEMA hydrogels as calculated by Live-Dead Assay and NIH Image-J program. Cells synthesized representative collagens and proteoglycans in the hydrogels indicating that they preserved their keratocyte functions. Transparency of the cell loaded GelMA-HEMA hydrogels was increased significantly up to 90% at 700 nm during three weeks of incubation and was comparable with the transparency of native cornea. Cell loaded GelMA-HEMA corneal stroma model is novel and reported for the first time in the literature in terms of introduction of cells during the preparation phase of the hydrogels. The appropriate mechanical strength and high transparency of the cell loaded constructs indicates a viable alternative to the current devices used in the treatment of corneal blindness.

Depth-Dependent Out-of-Plane Young's Modulus of the Human Cornea

Purpose/Aim: Despite their importance in accurate mechanical modeling of the cornea, the depth-dependent material properties of the cornea have only been partially elucidated. In this work, we characterized the depth-dependent out-of-plane Young's modulus of the central and peripheral human cornea with high spatial resolution.

MATERIALS AND METHODS

Central and peripheral corneal buttons from human donors were subjected to unconfined axial compression followed by stress relaxation for 30 min. Sequences of fluorescent micrographs of full-thickness corneal buttons were acquired throughout the experiment to enable tracking of fluorescently labeled stromal keratocyte nuclei and measurements of depth-dependent infinitesimal strains. The nominal (gross) out-of-plane Young's modulus and drained Poisson's ratio for each whole specimen was computed from the equilibrium stress and overall tissue deformation. The depth-dependent (local) out-of-plane Young's modulus was computed from the equilibrium stress and local tissue strain based on an anisotropic model (transverse isotropy).

RESULTS

The out-of-plane Young's modulus of the cornea exhibited a strong dependence on in-plane location (peripheral versus central cornea), but not depth. The depth-dependent out-of-plane Young's modulus of central and peripheral specimens ranged between 72.4-102.4 kPa and 38.3-58.9 kPa. The nominal out-of-plane Young's modulus was 87 ± 41.51 kPa and 39.9 ± 15.28 kPa in the central and peripheral cornea, while the drained Poisson's ratio was 0.05 ± 0.02 and 0.07 ± 0.04.

CONCLUSIONS

The out-of-plane Young's modulus of the cornea is mostly independent of depth, but not in-plane location (i.e. central vs. peripheral). These results may help inform more accurate finite element computer models of the cornea.

Evaluation of Endothelial Pump Function in Fuchs Endothelial Dystrophy Before and After Endothelial Keratoplasty

PURPOSE

To evaluate the endothelial pump function in vivo after Descemet stripping automated endothelial keratoplasty (DSAEK).

METHODS

In a prospective controlled trial, a group of 17 patients with Fuchs endothelial corneal dystrophy (FECD) eligible for DSAEK surgery and a group of 15 patients with cataract but with normal corneas eligible for cataract surgery (controls) were formed. A low oxygen-permeable contact lens was used to induce corneal edema. Changes in central corneal thickness were monitored as an indirect measure of endothelial cell pump function. Experiments were performed before surgery and repeated 12 months after surgery.

RESULTS

Comparing the FECD and control groups before surgery, there was 24.8% (13.5-36.1) more edema in the FECD group after 2 hours (P < 0.001) and 19.9% (8.6-31.3) more edema in the FECD group after 3 hours (P < 0.001). In the FECD group, there was 15% (3.1-26.9) less edema after DSAEK than before surgery (P = 0.015) after 3 hours. Comparing the DSAEK-treated eyes with the control eyes 12 months after surgery; there was 12.8% (3.5-22.1) more edema in the DSAEK group after 2 hours (P = 0.007), but after 3 hours, the percentages of edema were similar (P = 0.11).

CONCLUSIONS

Twelve months after DSAEK surgery, the grafted endothelium cleared the induced edema as fast as the control group, indicating a viable and near-normal endothelial pump function. However, significant differences in the deswelling patterns were detected, which may be caused by the added corneal stroma after DSAEK.

A structural model for the in vivo human cornea including collagen-swelling interaction

A structural model of the in vivo cornea, which accounts for tissue swelling behaviour, for the three-dimensional organization of stromal fibres and for collagen-swelling interaction, is proposed. Modelled as a binary electrolyte gel in thermodynamic equilibrium, the stromal electrostatic free energy is based on the mean-field approximation. To account for active endothelial ionic transport in the in vivo cornea, which modulates osmotic pressure and hydration, stromal mobile ions are shown to satisfy a modified Boltzmann distribution. The elasticity of the stromal collagen network is modelled based on three-dimensional collagen orientation probability distributions for every point in the stroma obtained by synthesizing X-ray diffraction data for azimuthal angle distributions and second harmonic-generated image processing for inclination angle distributions. The model is implemented in a finite-element framework and employed to predict free and confined swelling of stroma in an ionic bath. For the in vivo cornea, the model is used to predict corneal swelling due to increasing intraocular pressure (IOP) and is adapted to model swelling in Fuchs' corneal dystrophy. The biomechanical response of the in vivo cornea to a typical LASIK surgery for myopia is analysed, including tissue fluid pressure and swelling responses. The model provides a new interpretation of the corneal active hydration control (pump-leak) mechanism based on osmotic pressure modulation. The results also illustrate the structural necessity of fibre inclination in stabilizing the corneal refractive surface with respect to changes in tissue hydration and IOP.

Hydration dependent viscoelastic tensile behavior of cornea

The cornea is a protective transparent connective tissue covering the front of the eye. The standard uniaxial tensile experiments are among the most popular techniques for investigating biomechanical properties of the cornea. This experimental method characterizes the stress-strain response of corneal strips immersed in a bathing solution. In the present study, the important roles of corneal hydration on tensile viscoelastic properties were investigated. The thickness was used as a surrogate for hydration and uniaxial tensile experiments were performed on bovine corneal samples with four different average thickness (hydration), i.e., 1100 μm (4.87 mg water/mg dry tissue), 900 μm (4.13 mg water/mg dry tissue), 700 μm (3.20 mg water/mg dry tissue), and 500 μm (1.95 mg water/mg dry tissue). The samples were immersed in mineral oil in order to prevent their swelling during the experiments. A quasilinear viscoelastic (QLV) model was used to analyze the experimental measurements and determine viscoelastic material constants. It was observed that both maximum and equilibrium (relaxed) stresses were exponentially increased with decreasing tissue thickness (hydration). Furthermore, the QLV model successfully captured the corneal viscoelastic response with an average R (2) value greater than 0.99. Additional experiments were conducted in OBSS in order to confirm that these significant changes in viscoelastic properties were because of corneal hydration and not the bathing solution. The findings of this study suggest that extra care must be taken in interpreting the results of earlier uniaxial tensile testings and their correspondence to the corneal biomechanical properties.

Mechanisms of self-organization for the collagen fibril lattice in the human cornea

The transparency of the human cornea depends on the regular lattice arrangement of the collagen fibrils and on the maintenance of an optimal hydration--the achievement of both depends on the presence of stromal proteoglycans (PGs) and their linear sidechains of negatively charged glycosaminoglycans (GAGs). Although the GAGs produce osmotic pressure by the Donnan effect, the means by which they exert positional control of the lattice is less clear. In this study, a theoretical model based on equilibrium thermodynamics is used to describe restoring force mechanisms that may control and maintain the fibril lattice and underlie corneal transparency. Electrostatic-based restoring forces that result from local charge density changes induced by fibril motion, and entropic elastic restoring forces that arise from duplexed GAG structures that bridge neighbouring fibrils, are described. The model allows for the possibility that fibrils have a GAG-dense coating that adds an additional fibril force mechanism preventing fibril aggregation. Swelling pressure predictions are used to validate the model with results showing excellent agreement with experimental data over a range of hydration from 30 to 200% of normal. The model suggests that the electrostatic restoring force is dominant, with the entropic forces from GAG duplexes being an order or more smaller. The effect of a random GAG organization, as observed in recent imaging, is considered in a dynamic model of the lattice that incorporates randomness in both the spatial distribution of GAG charge and the topology of the GAG duplexes. A striking result is that the electrostatic restoring forces alone are able to reproduce the image-based lattice distribution function for the human cornea, and thus dynamically maintain the short-range order of the lattice.

Swelling pressure and hydration behavior of porcine corneal stroma

PURPOSE

The aim of this study was to characterize swelling pressure-thickness, swelling pressure-hydration and hydration-thickness relations of porcine cornea.

METHODS

Mechanical compression tests and free swelling experiments were performed on porcine cornea. A rheometer (DHR-2, TA Instruments) with a thermally controlled fluid chamber filled with 0.9% NaCl solution was used to measure the equilibrium swelling pressure of (n = 17) corneal stromal specimens. The samples were compressed incrementally and their swelling pressure-thickness relations were obtained. In parallel to this investigation, a transient digital imaging microscope (H800-CL, American Scope Inc.), a USB autofocus camera (UM05, ViTiny), and a precision weighing scale (AGZN100, Torbal) were simultaneously used to measure the weight-thickness relation of (n = 8) corneal specimens. This experimental study gave the thickness-hydration relationship required for expressing swelling pressure measurements as a function of hydration.

RESULTS

At the in vivo 666 ± 68 µm central corneal thickness, an average swelling pressure of 52 ± 13 mmHg and hydration of 3.36 ± 0.25 mg H2O/mg dry tissue were found. The swelling pressure was reported as functions of both tissue thickness and hydration. The average fixed charge density of ρF/F ~ 42.8 mM and dry density of 1.47±0.15 g/cm3 were found. The thickness-hydration relationship was only linear when the tissue thickness was within the range of physiological thickness.

CONCLUSION

Overall, the physiological hydration and swelling pressure of the porcine cornea were within the same range of those reported previously for other mammalian corneas such as steers, rabbits and humans. Nevertheless, the thickness-hydration behavior of the porcine cornea was only similar to that of the human cornea.

A new method to determine rate-dependent material parameters of corneal extracellular matrix

The cornea protects internal ocular contents against external insults while refracting and transmitting the incoming light onto the lens. The biomechanical properties of the cornea are largely governed by the composition and structure of the stromal layer which is an extracellular matrix composed of collagen fibrils embedded in a hydrated soft matrix. The mechanical behavior of the corneal stroma has commonly been characterized using uniaxial tensile tests and inflation experiments. In the present study, unconfined compression experiments were used to investigate the influence of loading rates on compressive behavior of nineteen porcine corneal specimens. The experiments were performed at ramp displacement rates 0.15 μm/s (eight samples), 0.5 μm/s (six samples), and 1.0 μm/s (five samples). For all tests, a maximum compressive strain of 50% (five strain increments of 4% followed by three strain increments of 10%) was selected. The experimental data was analyzed by a transversely isotropic biphasic model and material parameters, i.e., the in-plane Young's modulus, the out-of-plane Young's modulus, and the permeability coefficient were calculated. It was observed that while the permeability coefficient decreased exponentially with increasing compressive strain, the in-plane and out-of-plane Young's moduli increased exponentially with increasing strain. Furthermore, it was found that the equilibrium stress was almost rate independent.

The role of 3-D collagen organization in stromal elasticity: a model based on X-ray diffraction data and second harmonic-generated images

Examining the cross-section of the human cornea with second harmonic-generated (SHG) imaging shows that many lamellae do not lie parallel to the cornea's anterior surface but have inclined trajectories that take them through the corneal thickness with a depth-dependent distribution. A continuum mechanics-based model of stromal elasticity is developed based on orientation information extracted and synthesized from both X-ray scattering studies and SHG imaging. The model describes the effects of inclined lamella orientation by introducing a probability function that varies with depth through the stroma, which characterizes the range and distribution of lamellae at inclined angles. When combined with the preferred lamellar orientations found from X-ray scattering experiments, a fully 3-D representation of lamella orientation is achieved. Stromal elasticity is calculated by a weighted average of individual lamella properties based on the spatially varying 3-D orientation distribution. The model is calibrated with in vitro torsional shear experiments and in vivo indentation data and then validated with an in vitro inflation study. A quantitative explanation of the experimentally measured depth dependence of mechanical properties emerges from the model. The significance of the 3-D lamella orientation in the mechanics of the human cornea is demonstrated by investigating and contrasting the effects of previous modeling assumptions made on lamella orientation.

Depth-dependent transverse shear properties of the human corneal stroma

PURPOSE

To measure the transverse shear modulus of the human corneal stroma and its profile through the depth by mechanical testing, and to assess the validity of the hypothesis that the shear modulus will be greater in the anterior third due to increased interweaving of lamellae.

METHODS

Torsional rheometry was used to measure the transverse shear properties of 6 mm diameter buttons of matched human cadaver cornea pairs. One cornea from each pair was cut into thirds through the thickness with a femtosecond laser and each stromal third was tested individually. The remaining intact corneas were tested to measure full stroma shear modulus. The shear modulus from a 1% shear strain oscillatory test was measured at various levels of axial compression for all samples.

RESULTS

After controlling for axial compression, the transverse shear moduli of isolated anterior layers were significantly higher than central and posterior layers. Mean modulus values at 0% axial strain were 7.71 ± 6.34 kPa in the anterior, 1.99 ± 0.45 kPa in the center, 1.31 ± 1.01 kPa in the posterior, and 9.48 ± 2.92 kPa for full thickness samples. A mean equilibrium compressive modulus of 38.7 ± 8.6 kPa at 0% axial strain was calculated from axial compression measured during the shear tests.

CONCLUSIONS

Transverse shear moduli are two to three orders of magnitude lower than tensile moduli reported in the literature. The profile of shear moduli through the depth displayed a significant increase from posterior to anterior. This gradient supports the hypothesis and corresponds to the gradient of interwoven lamellae seen in imaging of stromal cross-sections.

Riboflavin-ultraviolet light induced cross-linking in endothelial decompensation

PURPOSE

To evaluate the potential of collagen cross-linking in the treatment of corneal oedema caused by endothelial decompensation.

METHODS

Riboflavin-ultraviolet (UV) treatment induces cross-linking and reduces stromal swelling. Eleven patients with corneal oedema were treated. The technique comprised: epithelial abrasion; instillation of 0.1% riboflavin in saline, and 5.4 J/cm(2) illumination with 365 nm UV-A light over approximately 30 mins (3 mW/cm(2)).

RESULTS

A reduction in corneal thickness was observed in 10 patients. The majority also experienced improvement in vision. The effect occurred over weeks and lasted for months.

CONCLUSIONS

The study shows a potential application of collagen cross-linking in the management of patients with corneal oedema. Experimental and additional clinical studies are necessary in order to define the precise indications for this type of treatment.

Swelling of the collagen-keratocyte matrix of the bovine corneal stroma ex vivo in various solutions and its relationship to tissue thickness

AIM

The mammalian corneal stroma, like some other connective tissues, can absorb fluid, swell and become oedematous. Since studies on the corneal stroma have been carried out with different types of preparations and solutions, inter-study comparisons are very difficult. A study was thus undertaken on a standardised preparation to assess the relative magnitude of this swelling and its relationship to thickness of the preparations.

METHODS

From selected recent post-mortem eyes of adult cattle, stroma preparations were cut from the central part of the cornea. These preparations were immersed in various solutions of known pH and osmolality, and the time-dependent changes in wet mass were assessed over 9 h at 37 degrees C. The relative rates and magnitude of the swelling of the tissue were then compared.

RESULTS

A reference value for stromal swelling was obtained by incubation in a 35 mM bicarbonate-buffered mixed salts solution equilibrated with 5% CO2-air (pH 7.60) where a 3.39-fold increase in wet mass and a 4.58-fold increase in thickness was realised in 9 h, at an initial rate of 76 +/- 3%/h. The swelling was essentially the same in an organic buffer-mixed salt solution (pH 7.5) but progressively greater in phosphate-buffered saline (pH 7.5), a range of phosphate buffers (10-67 mM, pH 7.5), NaCl solutions (0.025-1%) and with gross swelling observed in water (where a 15.9-fold increase in wet mass occurred along with a 25-fold increase in thickness, at an initial rate of 643 +/- 62%/h). Overall, the wet mass changes were strongly related to thickness (P < 0.001).

CONCLUSIONS

The results confirm that the selection of solution(s) for studies on corneal stromal swelling is critical. The swelling (oedema) is lower in a physiologically-relevant solution (similar to the aqueous humour of the eye). This indicates that the swelling tendency of the corneal stroma has been overestimated in the past, and that a similar discrepancy may also exist for studies on other connective tissues ex vivo when non-physiological experimental solutions are used.

Re-assessment of the potential impact of physiologically relevant pH changes on the hydration properties of the isolated mammalian corneal stroma

The pH sensitivity of the swelling of the mammalian corneal stroma was reinvestigated to assess whether or not there were detectable differences in the hydration properties of this collagen-keratocyte matrix within a physiologically relevant range (as opposed to extremes of acid or alkaline pH) and at a physiologically relevant temperature. From recent post-mortem eyes of adult cows, square (8 x 8 mm) samples of corneal stroma were prepared and incubated in an isotonic, buffered (HEPES etc.), mixed salts solution with added glucose at 37 degrees C. The time-dependent changes in wet mass were assessed over 24 h. The rate and magnitude of stromal swelling were different within the range of pH 6.5-8.5. The wet mass of stromal samples increased almost 2-fold within 1 h, and then at lesser rates to realise 3.25-3.75-fold and 4-5-fold increases in wet mass by 9 h and 24 h respectively. The maximum increases were observed at pH 7.25-7.5, with most of the effect being the result of differences in the initial rate of swelling. The discontinuous swelling and the pH effect on the rates of swelling were also evident when the data were fitted to a previous kinetic model (Elliott et al., J. Physiol. (Lond.) 298 (1980) 453-470). It is concluded that pH changes in the physiological range can have a small but reproducible impact on the swelling kinetics of the isolated mammalian corneal stroma ex vivo.

Effect of surface photorefractive keratectomy and laser in situ keratomileusis on the corneal endothelium

PURPOSE

To investigate endothelial cell loss in pairs of fresh human autopsy globes following high-diopter myopic photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK).

SETTING

Center for Research on Ocular Therapeutics and Biodevices and Magill Laser Center for Vision Correction, Storm Eye Institute, Charleston, South Carolina, USA.

METHODS

In the first part of the study, 12 globes had either -10 diopters (D) multizone surface PRK or -10 D single-zone LASIK. In the second part, three groups of 5 globes each had -15 D, -20 D, or -25 D multizone-blend LASIK procedures. Fellow globes in both groups were used as untreated controls. Corneoscleral buttons were excised from all globes. Following 7 days in corneal organ culture, the endothelial surface was stained with two vital dyes: calcein-AM and ethidium homodimer. Fluorescence microscopy was used to obtain endothelial cell counts.

RESULTS

The mean dead cells per square millimeter (cells/mm2) were 0.94 in the -10 D PRK treated corneas compared with 0.91 in the fellow untreated eyes (P = 0.06(. The mean dead cells/mm2 in the -10 D single-zone LASIK-treated corneas and in the fellow untreated eyes were 0.61 (P = 0.88). The mean dead cells/mm2 in the -15 D, -20 D, and -25 D multizone-blend LASIK-treated corneas were 3.08, 2.33, and 5.55, respectively, compared with 3.49, 1.92, and 5.01 in the fellow untreated eyes (P = 0.276, P = 0.339, and P = 0.427, respectively). Dead cell counts for treated and control paired corneas were highly correlated in all treatment groups.

CONCLUSIONS

No significant endothelial cell loss occurred after -10 D PRK or LASIK corrections up to -25 D. Although this study has limitations that prevent direct extrapolation to the clinical situation, it does afford a comparable clinical correlate for endothelial cell toxicity following a typical excimer laser ablations.

Regional elastic performance of the human cornea

The regional mechanical performance of the cornea and limbus was studied in vitro by pressure loading of 18 intact human eyes. The pressure-induced (2-100 mmHg) meridional and circumferential tangential mechanical strains of the epi-and endothelial side of the cornea were measured at the centre, the para-centre, the periphery and the limbus. Strains were computed from digital measures of distances between tiny mercury droplet markers fixed on the corneal surfaces. Corresponding in-plane membrane stresses were calculated from measurements of the regional meridional and circumferential radius of curvature and from measurements of the corneal thickness of the four regions. Young's moduli of elasticity were computed for each region in the meridional and circumferential direction assuming orthotropic elastic behaviour of the corneal stroma. A power function was used to fit the non-linear elastic stress-strain relationships. The pressure-induced meridional strains were smallest at the corneal paracentre and periphery, and largest at the limbus. The circumferential strains varied less between regions with the para-centre straining most. In the meridional direction, Young's modulus of elasticity was highest at the central and para-central corneal regions, whereas the highest circumferential elastic modulus was found at the limbus. This study supports the notation of circumferentially orientated reinforcing structures in human limbal tissue. The para-central region of the human cornea was found stiffer in the meridional direction compared with the circumferential direction, suggesting a meridionally orientated reinforcement of the para-central parts of the human cornea. These findings may have important implications for mechanical modelling of keratorefractive procedures.

Chloride binding in the stroma of cultured human corneas

In the ox cornea, more than half of the non-diffusible, matrix negative charge is derived from the binding of free chloride ions. Because the magnitude of the net matrix charge is the dominant factor which determines the degree of stromal swelling, we investigated whether this phenomenon, stromal chloride binding, also occurs in human corneal stroma. Intrastromal ion concentrations were measured with radio-isotopes when human (outdated Eye Bank) corneas or (fresh) bovine corneas, physically clamped to maintain a constant hydration, were incubated in buffered 154 mM NaCl. The intrastromal chloride ion concentration was compared to the normalized concentrations of trace quantities of radio-labelled acetate and lactate ions. For human corneas, the intrastromal chloride ion concentration was found to be significantly higher (P < 0.001, t-test) than the normalized concentrations of both acetate and lactate ([Cl]i = 142.5 +/- 0.9 mM, (n = 9); [acetate]i = 131.2 +/- 1.2 mM, (n = 8); [lactate]i = 131.9 +/- 1.5 mM, (n = 5); all values are mean +/- S.E.M.). The sodium ion concentration was elevated ([Na]i = 176.0 +/- 1.8 mM, (n = 9)). These results demonstrate that chloride binding occurs to a significant extent in cultured human corneal stroma and suggest that chloride binding may be evident in the native human cornea.

Extensibility of the normo-hydrated human cornea

The extensibility of 10 human corneas was evaluated in vitro by measuring central epithelial side and endothelial side tangential strain induced by intraocular pressure loads ranging from 2 to 100 mmHg. Corneal normo-hydration was attempted by immersing and perfusing the eyes with 8% Dextran 500 in isotonic saline. The relationship between corneal strain and intraocular pressure was found to be non-linear, showing a typical stress-stiffening behaviour. Strain changes were approximately 10% higher on the endothelial side compared with the epithelial side. This difference could be fully explained by pressure induced changes in corneal volume. Compared to previous experiments performed on swollen corneas, the stiffness of the normo-hydrated human cornea was found to be higher. Young's modulus of elasticity for the corneal stroma was estimated to 3, 9, and 20 MPa for intraocular pressure intervals of 2-10, 10-25, and 25-100 mmHg, respectively.

The measurement of ox corneal swelling pressure by osmometry

1. Ox corneal stromal swelling pressure (gel pressure) may be measured by osmometry: polyethylene glycol of nominal molecular mass 10,000 Da (PEG 10K) is a suitable non-penetrating solute. 2. Corneal hydrations equilibrate within 4 h of exposure to 154 mM-NaCl including various concentrations (2-8%) of PEG 10K, providing that the epithelium covers the anterior surface and Descemet's membrane covers the posterior surface. At equilibrium hydration, corneal gel pressure equals the external osmotic pressure contributed by PEG 10K. 3. The osmotic pressure of PEG 10K may be calibrated using Descemet's membrane as the semi-permeable membrane. 4. Corneal gel pressure decreases with increasing hydration. 5. The relationship may be adequately explained by the Donnan theory of corneal swelling with a fixed negative matrix charge of 39.5 +/- 0.8 mequiv l-1 at physiological hydration of 3.2 at this salt concentration (154 mM-NaCl).