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This ex vivo study assesses the impact on CXL effectiveness, as measured by tissue enzymatic resistance and confocal microscopy, of including a pre-UVA corneal surface rinse with balanced salt solution (BSS) as part of the epithelium-off treatment protocol.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Sixty-eight porcine eyes, after epithelial debridement, were assigned to six groups in three experimental runs. Group 1 remained untreated. Groups 2\u20136 received a 16-min application of 0.1% riboflavin\/Hydroxypropyl methylcellulose (HPMC) drops, after which Group 3 was exposed to 9\u00a0mW\/cm<jats:sup>2<\/jats:sup> UVA for 10\u00a0min, and Groups 4\u20136 underwent corneal surface rinsing with 0.25\u00a0mL, 1\u00a0mL or 10\u00a0mL BSS followed by 9\u00a0mW\/cm<jats:sup>2<\/jats:sup> UVA exposure for 10\u00a0min. Central corneal thickness (CCT) was recorded at each stage. Central 8.0\u00a0mm corneal buttons from all eyes were subjected to 0.3% collagenase digestion at 37\u00a0\u00b0C and the time required for complete digestion determined. A further 15 eyes underwent fluorescence confocal microscopy to assess the impact of rinsing on stromal riboflavin concentration.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Application of riboflavin\/HPMC solution led to an increase in CCT of 73\u2009\u00b1\u200914 \u00b5m (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) after 16\u00a0min. All CXL-treated corneas displayed a 2\u20134\u00a0fold greater resistance to collagenase digestion than non-irradiated corneas. There was no difference in resistance between corneas that received no BSS rinse and those that received a 0.25\u00a0mL or 1\u00a0mL pre-UVA rinse, but each showed a greater level of resistance than those that received a 10\u00a0mL pre-UVA rinse (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Confocal microscopy demonstrated reduced stromal riboflavin fluorescence after rinsing.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>All protocols, with and without rinsing, were effective at enhancing the resistance to collagenase digestion, although resistance was significantly decreased, and stromal riboflavin fluorescence reduced with a 10\u00a0mL rinse. This suggests that a 10\u00a0mL surface rinse can reduce the efficacy of CXL through the dilution of the stromal riboflavin concentration.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40662-024-00375-4","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T01:02:03Z","timestamp":1709082123000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An in vitro investigation into the impact of corneal rinsing on riboflavin\/UVA corneal cross-linking"],"prefix":"10.1186","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4322-5763","authenticated-orcid":false,"given":"Si\u00e2n R.","family":"Morgan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David P. 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