Advances in the Standards & Applied Sciences

Advances in the Standards & Applied Sciences

Modeling and Biomechanical Analysis of Keratoconus

Document Type : Original Article

Authors
1 Department of Biomedical Engineering, Faculty of Medical Sciences and Technologies, Islamic Azad University, Science and Research Branch, Tehran, Iran.
2 Biomedical Engineering Research Group, Research Center of Technology and Engineering, Standard Research Institute, Karaj, Iran
3 Department of Biomechanics, Science and Research Branch, Islamic Azad University, Tehran, Iran.
Abstract
Keratoconus is a non-inflammatory ocular disorder in which the cornea bulges in the shape of a cone. Therefore, this progressive disease will cause visual impairment. The precise aetiology of keratoconus is not well understood. Investigating the pathogenesis of keratoconus from a biomechanical point of view will determine which biomechanical factor plays the dominant role in keratoconus formation. In this study, using the finite element method, a three-dimensional model of the human cornea with anatomical dimensions was created, and hyperelastic isotropic properties were assigned to it. Then, the inner surfaces of the model were subjected to physiological intraocular pressure. This model was regarded as a healthy cornea and as a reference model. Then, two symmetric and asymmetric states of keratoconus were simulated. For this purpose, a circular region was created in the center of the cornea (for the symmetric state) or in one of its quarters (for the asymmetric state), and then, in this circular region (i.e., locally), the following operations were performed with three different intensities to simulate three different stages of symmetric/asymmetric keratoconus: 1) reducing the thickness, 2) weakening the mechanical properties, and 3) reducing the thickness and weakening the mechanical properties, simultaneously. By analyzing the displacements, it was found that the local weakening of the mechanical properties makes the cornea significantly steep in the area affected by the disease and causes keratoconus formation. Therefore, in keratoconus formation, the weakening of mechanical properties plays a primary role, and the reduction of thickness plays a secondary and auxiliary role.
Keywords
Subjects

[1]          C. E. Willoughby, D. Ponzin, S. Ferrari, A. Lobo, K. Landau, and Y. Omidi, “Anatomy and physiology of the human eye: effects of mucopolysaccharidoses disease on structure and function–a review,” Clin. Experiment. Ophthalmol., vol. 38, pp. 2–11, 2010, doi.org/10.1111/j.1442-9071.2010.02363.x.
[2]          A. Gefen, R. Shalom, D. Elad, and Y. Mandel, “Biomechanical analysis of the keratoconic cornea,” J. Mech. Behav. Biomed. Mater., vol. 2, no. 3, pp. 224–236, 2009, doi.org/10.1016/j.jmbbm.2008.07.002.
[3]          A. Pandolfi and F. Manganiello, “A model for the human cornea: constitutive formulation and numerical analysis,” Biomech. Model. Mechanobiol., vol. 5, no. 4, pp. 237–246, 2006, doi.org/10.1007/s10237-005-0014-x.
[4]          A. Benoit, G. Latour, S.-K. Marie-Claire, and J.-M. Allain, “Simultaneous microstructural and mechanical characterization of human corneas at increasing pressure,” J. Mech. Behav. Biomed. Mater., vol. 60, pp. 93–105, 2016, doi.org/10.1016/j.jmbbm.2015.12.031.
[5]          R. Ambekar, K. C. Toussaint Jr, and A. W. Johnson, “The effect of keratoconus on the structural, mechanical, and optical properties of the cornea,” J. Mech. Behav. Biomed. Mater., vol. 4, no. 3, pp. 223–236, 2011, doi.org/10.1016/j.jmbbm.2010.09.014.
[6]          Y. S. Rabinowitz, “Keratoconus,” Surv. Ophthalmol., vol. 42, no. 4, pp. 297–319, 1998, doi.org/10.1016/S0039-6257(97)00119-7.
[7]          H. R. Vellara and D. V Patel, “Biomechanical properties of the keratoconic cornea: a review,” Clin. Exp. Optom., vol. 98, no. 1, pp. 31–38, 2015, doi.org/10.1111/cxo.12211.
[8]          R. Asher, A. Gefen, E. Moisseiev, and D. Varssano, “Etiology of Keratoconus: proposed biomechanical pathogenesis,” Silico Cell Tissue Sci., vol. 1, no. 1, p. 3, 2014, doi.org/10.1186/2196-050X-1-3.
[9]          L. A. Carvalho et al., “Keratoconus prediction using a finite element model of the cornea with local biomechanical properties,” Arq. Bras. Oftalmol., vol. 72, no. 2, pp. 139–145, 2009, doi.org/10.1590/S0004-27492009000200002.
[10]        A. S. Roy and W. J. Dupps, “Patient-specific computational modeling of keratoconus progression and differential responses to collagen cross-linking,” Invest. Ophthalmol. Vis. Sci., vol. 52, no. 12, pp. 9174–9187, 2011, doi.org/10.1167/iovs.11-7395.
[11]        J. R. Crouch, J. C. Merriam, and E. R. Crouch, “Finite element model of cornea deformation,” in International Conference on Medical Image Computing and Computer-Assisted Intervention, 2005, pp. 591–598, doi.org/10.1007/11566489_73.
[12]        E. Lanchares, B. Calvo, J. A. Cristóbal, and M. Doblaré, “Finite element simulation of arcuates for astigmatism correction,” J. Biomech., vol. 41, no. 4, pp. 797–805, 2008, doi.org/10.1016/j.jbiomech.2007.11.010.
[13]        R. Grytz and G. Meschke, “A computational remodeling approach to predict the physiological architecture of the collagen fibril network in corneo-scleral shells,” Biomech. Model. Mechanobiol., vol. 9, no. 2, pp. 225–235, 2010, doi: 10.1007/s10237-009-0173-2.
[14]        J. Flecha-Lescún, B. Calvo, J. Zurita, and M. Á. Ariza-Gracia, “Template-based methodology for the simulation of intracorneal segment ring implantation in human corneas,” Biomech. Model. Mechanobiol., vol. 17, no. 4, pp. 923–938, 2018, doi: 10.1007/s10237-018-1013-z.
[15]        L. Torquetti, R. F. Berbel, and P. Ferrara, “Long-term follow-up of intrastromal corneal ring segments in keratoconus,” J. Cataract Refract. Surg., vol. 35, no. 10, pp. 1768–1773, 2009, doi.org/10.1016/j.jcrs.2009.05.036.
[16]        C. J. Roberts and W. J. Dupps Jr, “Biomechanics of corneal ectasia and biomechanical treatments,” J. Cataract Refract. Surg., vol. 40, no. 6, pp. 991–998, 2014, doi.org/10.1016/j.jcrs.2014.04.013.
[17]        M. A. Lago et al., “A new methodology for the in vivo estimation of the elastic constants that characterize the patient-specific biomechanical behavior of the human cornea,” J. Biomech., vol. 48, no. 1, pp. 38–43, 2015, doi.org/10.1016/j.jbiomech.2014.11.009.
[18]        R. Asher, A. Gefen, E. Moisseiev, and D. Varssano, “An Analytical Approach to Corneal Mechanics for Determining Practical, Clinically-Meaningful Patient-Specific Tissue Mechanical Properties in the Rehabilitation of Vision,” Ann. Biomed. Eng., vol. 43, no. 2, pp. 274–286, 2015, doi: 10.1007/s10439-014-1147-9.
[19]        M. A. Lago et al., “Patient-specific simulation of the intrastromal ring segment implantation in corneas with keratoconus,” J. Mech. Behav. Biomed. Mater., vol. 51, pp. 260–268, 2015, doi.org/10.1016/j.jmbbm.2015.07.023.