Corneal Biomechanics After Intrastromal Ring Surgery: Optomechanical In Silico Assessment

PURPOSE: To provide a biomechanical framework to better understand the postsurgical optomechanical behavior of the cornea after ring implantation. METHODS: Calibrated in silico models were used to determine the corneal shape and stresses after ring implantation. After mechanical simulations, geometric ray-tracing was used to determine the change in spherical equivalent. The effect of the surgical procedure, circadian variation of intraocular pressure, or the biomechanical weakening introduced by keratoconus (KC) were evaluated for each intrastromal ring. RESULTS: Models predicted the postsurgical optomechanical response of the cornea at a population level. The localized mechanical effect of the additional intrastromal volume introduced by the implants (size and diameter) drives the postsurgical corneal response. However, central corneal stresses did not increase more than 50%, and thus implants did not strengthen the cornea globally. Because of the biomechanical weakening introduced by laser pocketing, continuous implants in a pocket resulted in higher refractive corrections and in the relaxation of the anterior stroma, which could slow down KC progression. Implants can move within the stroma, acting as a dynamic pivot point that modifies corneal kinematics and flattens the corneal center. Changes in stromal mechanical properties did not impact on refraction for normal or pathological corneas. CONCLUSIONS: Implants do not stiffen the cornea but create a local bulkening effect that regularizes the corneal shape by modifying corneal kinematics without canceling corneal motion. TRANSLATIONAL RELEVANCE: In silico models can help to understand corneal biomechanics, to plan patient-specific interventions, or to create biomechanically driven nomograms.