Inverse solution of corneal material parameters based on non-contact tonometry: A comparative study of different constitutive models

Biaxial hyperelastic and anisotropic behaviors of the corneal anterior central stroma along the preferential fibril orientations. Part I: Measurement and calibration of personalized stress-strain curves

Lacking specimens is the biggest limitation of studying the mechanical behaviors of human corneal. Extracting stress-strain curves is the crucial step in investigating hyperelastic and anisotropic properties of human cornea. 15 human corneal specimens extracted from the small incision lenticule extraction (SMILE) surgery were applied in this study. To accurately measure the personalized true stress-strain curve using corneal lenticules, the digital image correlation (DIC) method and finite element method were used to calibrate the stress and the strain of the biaxial extension test. The hyperelastic load-displacement curves obtained from the biaxial extension test were performed in preferential fibril orientations, which are arranged along the nasal-temporal (NT) and the superior-inferior (SI) directions within the anterior central stroma. The displacement and strain fields were accurately calibrated and calculated using the digital image correlation (DIC) method. A conversion equation was given to convert the effective engineering strain to the true strain. The stress field distribution, which was simulated using the finite element method, was verified. Based on this, the effective nominal stress with personalized characteristics was calibrated. The personalized stress-strain curves containing individual characteristic, like diopter and anterior surface curvature, was accurately measured in this study. These results provide an experimental method using biaxial tensile test with corneal lenticules. It is the foundation for investigating the hyperelasticity and anisotropy of the central anterior stroma of human cornea.

A detailed methodology to model the Non Contact Tonometry: a Fluid Structure Interaction study

Understanding the corneal mechanical properties has great importance in the study of corneal pathologies and the prediction of refractive surgery outcomes. Non-Contact Tonometry (NCT) is a non-invasive diagnostic tool intended to characterize the corneal tissue response in vivo by applying a defined air-pulse. The biomarkers inferred from this test can only be considered as indicators of the global biomechanical behaviour rather than the intrinsic biomechanical properties of the corneal tissue. A possibility to isolate the mechanical response of the corneal tissue is the use of an inverse finite element method, which is based on accurate and reliable modelling. Since a detailed methodology is still missing in the literature, this paper aims to construct a high-fidelity finite-element model of an idealized 3D eye for in silico NCT. A fluid-structure interaction (FSI) simulation is developed to virtually apply a defined air-pulse to a 3D idealized eye model comprising cornea, limbus, sclera, lens and humors. Then, a sensitivity analysis is performed to examine the influence of the intraocular pressure (IOP) and the structural material parameters on three biomarkers associated with corneal deformation. The analysis reveals the requirements for the in silico study linked to the correct reproduction of three main aspects: the air pressure over the cornea, the biomechanical properties of the tissues, and the IOP. The adoption of an FSI simulation is crucial to capture the correct air pressure profile over the cornea as a consequence of the air-jet. Regarding the parts of the eye, an anisotropic material should be used for the cornea. An important component is the sclera: the stiffer the sclera, the lower the corneal deformation due to the air-puff. Finally, the fluid-like behavior of the humors should be considered in order to account for the correct variation of the IOP during the test which will, otherwise, remain constant. The development of a strong FSI tool amenable to model coupled structures and fluids provides the basis to find the biomechanical properties of the corneal tissue in vivo.

Computational Modeling of Ophthalmic Procedures: Computational Modeling of Ophthalmic Procedures

PURPOSE

To explore how finite-element calculations can continue to contribute to diverse problems in ophthalmology and vision science, we describe our recent work on modeling the force on the peripheral retina in intravitreal injections and how that force increases with shorter, smaller gauge needles. We also present a calculation that determines the location and stress on a retinal pigment epithelial detachment during an intravitreal injection, the possibility that stress induced by the injection can lead to a tear of the retinal pigment epithelium.

BACKGROUND

Advanced computational models can provide a critical insight into the underlying physics in many surgical procedures, which may not be intuitive.

METHODS

The simulations were implemented using COMSOL Multiphysics. We compared the monkey retinal adhesive force of 18 Pa with the results of this study to quantify the maximum retinal stress that occurs during intravitreal injections.

CONCLUSIONS

Currently used 30-gauge needles produce stress on the retina during intravitreal injections that is only slightly below the limit that can create retinal tears. As retina specialists attempt to use smaller needles, the risk of complications may increase. In addition, we find that during an intravitreal injection, the stress on the retina in a pigment epithelial detachment occurs at the edge of the detachment (found clinically), and the stress is sufficient to tear the retina. These findings may guide physicians in future clinical research. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.