Optimization of surgical parameters based on patient-specific models: Application to arcuate keratotomy

Truffer, Oskar; Abler, Daniel; Pajic, Bojan; Grabner, Günther; Kraker, Hannes; Büchler, Philippe

doi:10.1016/j.jcrs.2019.02.022

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…Theoretical simulation plays an important role in improving clinical practice. For example, a numerical model can be adopted in clinical practice to plan and optimize refractive surgeries [11,12]. FEM can be a useful tool for providing insight into the effects of such alterations of material properties of the geometry and optical performance of the human eye.…”

Section: Introductionmentioning

confidence: 99%

Effects of the LASIK flap thickness on corneal biomechanical behavior: a finite element analysis

et al. 2020

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Background: It is well known that the biomechanical properties change after LASIK refractive surgery. One reason is the impact of flap creation on the residual stroma. The results have revealed that the change is closely related with the flap thickness in several studies. However, the quantitative relationships between the distributions of displacement and stress on the corneal surface and flap thickness have not been studied. The aim of the study was to quantify evaluate the biomechanical change caused by the LASIK flap. Methods: By building a finite element model of the cornea, the displacement, the stress and the strain on the corneal surface were analyzed. Results: The results showed that the corneal flap could obviously cause the deformation of the anterior corneal surface. For example, the displacement of the corneal vertex achieved 15 μm more than that without corneal flap, when the thickness of corneal flap was 120 μm thick. This displacement was enough to cause the change of aberrations in the human eyes. In the central part of the cornea, the stress on the anterior corneal surface increased with flap thickness. But the change in the stress on the posterior corneal surface was significantly less than that on the anterior surface. In addition, the stress in the central part of the anterior corneal surface increased significantly as the intra-ocular pressure (IOP) increase. Furthermore the increase of IOP had a clearly less effect on stress distribution at the edge of the cornea. Distributions of strain on the corneal surface were similar to those of stress. Conclusions: The changes in the biomechanical properties of cornea after refractive surgery should not be ignored.

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Section: Introductionmentioning

confidence: 99%

Effects of the LASIK flap thickness on corneal biomechanical behavior: a finite element analysis

et al. 2020

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“…In another published paper, a customised planning tool was used for computer modelling to simulate the biomechanics of the cornea. With this method, an astigmatism reduction from 1.24 ± 0.43 D preoperatively to 0.80 ± 0.50 postoperatively could be achieved, but intracorneal arcuate incisions were performed [ 37 ]. In our work, we arrived at analogous values with a similar calculatory approach, although we did not quite achieve the calculated values clinically.…”

Section: Discussionmentioning

confidence: 99%

Predictability of Astigmatism Correction by Arcuate Incisions with a Femtosecond Laser Using the Gaussian Approximation Calculation

Sanmillan,

Thumann,

Kropp

et al. 2023

Micromachines

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Planning astigmatic correction is a complex task. Biomechanical simulation models are useful for predicting the effects of the physical procedure on the cornea. Algorithms based on these models allow preoperative planning and simulate the outcome of patient-specific treatment. The objective of this study was to develop a customised optimisation algorithm and determine the predictability of astigmatism correction by femtosecond laser arcuate incisions. In this study, biomechanical models and Gaussian approximation curve calculations were used for surgical planning. Thirty-four eyes with mild astigmatism were included, and corneal topographies were evaluated before and after femtosecond laser-assisted cataract surgery with arcuate incisions. The follow-up time was up to 6 weeks. Retrospective data showed a significant reduction in postoperative astigmatism. A total of 79.4% showed a postoperative astigmatic value less than 1 D. Clinical refraction was significantly reduced from −1.39 ± 0.79 D preoperatively to −0.86 ± 0.67 D postoperatively (p 0.02). A positive reduction in topographic astigmatism was also observed (p < 0.00). The best-corrected visual acuity increased postoperatively (p < 0.001). We can conclude that customised simulations based on corneal biomechanics are a valuable tool for correcting mild astigmatism with corneal incisions in cataract surgery to improve postoperative visual outcomes.

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“…In arcuate keratectomy, Truffer et al [ 76 ] proposed an arcuate keratotomy scheme for personalized FE simulation. Virtual surgery was performed on patients, and a numerical model was used to optimize the surgical parameters of arcuate keratotomy, which could improve the reliability of postoperative astigmatism and reduce the risk of overcorrection.…”

Section: In Vitro Biomechanical Study Methods Of Eye Tissuementioning

confidence: 99%

Biomechanical analysis of ocular diseases and its in vitro study methods

Zhao

Yan

et al. 2022

BioMed Eng OnLine

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Ocular diseases are closely related to the physiological changes in the eye sphere and its contents. Using biomechanical methods to explore the relationship between the structure and function of ocular tissue is beneficial to reveal the pathological processes. Studying the pathogenesis of various ocular diseases will be helpful for the diagnosis and treatment of ocular diseases. We provide a critical review of recent biomechanical analysis of ocular diseases including glaucoma, high myopia, and diabetes. And try to summarize the research about the biomechanical changes in ocular tissues (e.g., optic nerve head, sclera, cornea, etc.) associated with those diseases. The methods of ocular biomechanics research in vitro in recent years are also reviewed, including the measurement of biomechanics by ophthalmic equipment, finite element modeling, and biomechanical analysis methods. And the preparation and application of microfluidic eye chips that emerged in recent years were summarized. It provides new inspiration and opportunity for the pathogenesis of eye diseases and personalized and precise treatment.

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Optimization of surgical parameters based on patient-specific models: Application to arcuate keratotomy

Cited by 14 publications

References 23 publications

Effects of the LASIK flap thickness on corneal biomechanical behavior: a finite element analysis

Effects of the LASIK flap thickness on corneal biomechanical behavior: a finite element analysis

Predictability of Astigmatism Correction by Arcuate Incisions with a Femtosecond Laser Using the Gaussian Approximation Calculation

Biomechanical analysis of ocular diseases and its in vitro study methods

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