Evaluating corneal cross-linking using Stress-Strain Index maps: a finite element study

Keratoconus (KC) is a progressive corneal ectasia leading to visual impairment if untreated. Corneal collagen cross-linking (CXL) is an effective treatment to halt KC progression by strengthening corneal biomechanics. However, current CXL treatments lack customization based on regional corneal stiff...

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Bibliographic Details
Published in:Journal of the Royal Society interface Vol. 22; no. 229; p. 20250234
Main Authors: Wang, Chenyan, Lou, Yuanwan, Ye, Yabo, Shen, Shuiyang, Bao, Fangjun, Wang, Junjie, Elsheikh, Ahmed
Format: Journal Article
Language:English
Published: England 01.08.2025
Subjects:
Biomechanical Phenomena
Collagen - chemistry
Collagen - metabolism
Cornea - metabolism
Cornea - pathology
Cornea - physiopathology
Corneal Cross-Linking
Cross-Linking Reagents
Finite Element Analysis
Humans
Keratoconus - drug therapy
Keratoconus - metabolism
Keratoconus - pathology
Keratoconus - physiopathology
Keratoconus - therapy
Models, Biological
Stress, Mechanical
keratoconus
Stress–Strain Index
biomechanics
collagen cross-linking
finite element analysis
ISSN:1742-5662, 1742-5662
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Summary:Keratoconus (KC) is a progressive corneal ectasia leading to visual impairment if untreated. Corneal collagen cross-linking (CXL) is an effective treatment to halt KC progression by strengthening corneal biomechanics. However, current CXL treatments lack customization based on regional corneal stiffness, which is crucial for optimal outcomes. This study introduces a novel approach using Stress-Strain Index (SSI) maps to evaluate localized CXL effects on corneal biomechanics. Numerical modelling based on the finite element method was used to carry out inverse analysis of the human eye to simulate KC and CXL treatments, incorporating regional stiffness variations based on collagen fibril density. SSI maps were generated pre- and post-CXL to assess stiffness changes in treated regions. Results demonstrated that CXL increased corneal stiffness within the treated area, but the extent of stiffness recovery varied with CXL diameter and alignment with the KC cone. Smaller CXL diameters led to higher localized stiffness increases, while misalignment between CXL and KC areas resulted in suboptimal biomechanical restoration. The study highlights the potential of SSI mapping for personalized CXL treatments, enabling precise targeting of biomechanically weakened regions to restore corneal health. This approach contributes to the development of biomechanics-based customization of CXL therapies.
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ISSN:1742-5662
1742-5662
DOI:10.1098/rsif.2025.0234