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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| Vydáno v: | Journal of the Royal Society interface Ročník 22; číslo 229; s. 20250234 |
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| Hlavní autoři: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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England
01.08.2025
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| ISSN: | 1742-5662, 1742-5662 |
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| Abstract | 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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| AbstractList | 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.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. 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. |
| Author | Shen, Shuiyang Ye, Yabo Bao, Fangjun Elsheikh, Ahmed Lou, Yuanwan Wang, Chenyan Wang, Junjie |
| Author_xml | – sequence: 1 givenname: Chenyan orcidid: 0000-0003-4469-3083 surname: Wang fullname: Wang, Chenyan organization: College of Artificial Intelligence, Taiyuan University of Technology, Taiyuan, People's Republic of China – sequence: 2 givenname: Yuanwan surname: Lou fullname: Lou, Yuanwan organization: Oujiang Laboratory, Wenzhou, Zhejiang, People's Republic of China – sequence: 3 givenname: Yabo surname: Ye fullname: Ye, Yabo organization: Oujiang Laboratory, Wenzhou, Zhejiang, People's Republic of China – sequence: 4 givenname: Shuiyang surname: Shen fullname: Shen, Shuiyang organization: Oujiang Laboratory, Wenzhou, Zhejiang, People's Republic of China – sequence: 5 givenname: Fangjun surname: Bao fullname: Bao, Fangjun organization: ZheJiang-United Kingdom Joint Lab of Ocular Biomechanics, Wenzhou, People's Republic of China – sequence: 6 givenname: Junjie surname: Wang fullname: Wang, Junjie organization: Department of Ophthalmology, Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, People's Republic of China – sequence: 7 givenname: Ahmed orcidid: 0000-0001-7456-1749 surname: Elsheikh fullname: Elsheikh, Ahmed organization: National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK |
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| Keywords | keratoconus Stress–Strain Index biomechanics collagen cross-linking finite element analysis |
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| SubjectTerms | 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 |
| Title | Evaluating corneal cross-linking using Stress-Strain Index maps: a finite element study |
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