Corneoscleral Shell Research Articles

Spatially heterogeneous corneal mechanical responses before and after riboflavin–ultraviolet-A crosslinking

To determine the heterogeneous through-thickness strains in the cornea at physiologic intraocular pressures before and after corneal collagen crosslinking (CXL) using noninvasive ultrasound. Department of Biomedical Engineering, Ohio State University, Columbus, Ohio, USA. Experimental study. Sixteen paired canine corneoscleral shells were divided into 2 groups. The CXL group completed a standard CXL protocol using riboflavin-ultraviolet-A (UVA) irradiation. The control group was given an identical treatment except UVA irradiation. Ultrasound scans (at 55 MHz) of the cornea were obtained before and after treatment as the corneoscleral shell was inflated from 5 mm Hg to 45 mm Hg to calculate the distributive through-thickness strains in the cornea. The mean radial and tangential strains of the whole cornea layer, as well as those of the anterior, middle, and posterior thirds of the cornea, were compared before and after treatment in the control group and CXL group using linear mixed models with repeated measures. Significant reductions in tangential and radial strains occurred in the CXL group (P=.003 and P=.0025, respectively) but not the control group (P=.08 and P=.63, respectively). The anterior third had the smallest strains in all pretreated corneas (P<.001) and posttreated corneas (CXL group, P=.023; control group, P=.01). Ultrasound speckle tracking showed heterogeneous strain distributions through the cornea and confirmed that CXL results in a stiffer corneal response (ie, smaller strains during physiologic loadings). This technique may provide a clinical tool to quantify the biomechanical effects of CXL. No author has a financial or proprietary interest in any material or method mentioned.

Development of Tactile Eye Stiffness Sensor

This article describes the design of a novel trans-scleral tonometer based on the use of multiple force sensors forming a mechanical stiffness sensor. The approach is akin to an instrumented form of digital palpation tonometry in which manual paplation is used to infer the stiffness, and hence, the intraocular pressure of the eye. Force indentation data from multiple probes has been shown to correlate with the intraocular pressure (IOP) using encucleated porcine eyes. A noticeable amount of hysteresis has been observed during indentations at higher rate. Analysis of the experimental data indicates that stress relaxation (accommodation) in the visco-elastic corneo-scleral shell is the primary factor of the observed hysteresis. Further tests under different indentation rates show that the novel tonometer is expected to have an accuracy of ±1 mmHg when the indentation rate is kept below 0.5 mm/sec for pressure range of 10–35 mmHg. Using a calibrated finite element model of the measurement, the effect of lateral and angular misalignment is also examined. The results show that the position and orientation of the tactile sensor has to be controlled to within ±1 mm and ±3° in order to achieve a target accuracy of ±1 mmHg.

Trans-scleral tactile tonometry: An instrumented approach

This article describes a feasibility study of a novel trans-scleral tonometer based on the use of an instrumented form of digital palpation tonometry. Similar to manual digital palpation tonometery, trans-scleral tonometer utilizes two force probes offset by a fixed distance. Force indentation data from these probes have been shown to correlate with the intraocular pressure (IOP) of the eye. Enucleated porcine eyes were used to experimentally validate the approach. The observed hysteresis in the force data was analyzed using an analytical model that accounts for the outflow of the aqueous humor. The predictions of the model indicate that the primary reason behind the observed hysteresis is stress relaxation (accommodation) in the visco-elastic corneo-scleral shell. Experimental data from eye distention and indentation tests were then used to infer the conditions under which the novel tonometer would be expected to have an accuracy of ±1mmHg. Analysis of the data shows that indentation rates should be kept below 0.5mm/s for a pressure range of 10–35mmHg. Two commonly used pressure control protocols were tested in an effort to ensure accurate IOP values during the palpation tests. Due to the large increase of IOP during digital palpation, the trans-scleral (intra-vitreous) pressurization was found to be inadequate, leading to clogging of the line by the displaced vitreous. No such problems were identified when the eye was pressurized through the cornea and into the anterior chamber. Force data from multiple palpation experiments are used to generate calibration curves for a two-probe conceptual tonometer. The calibration showed that a 10mN of force variation corresponds to 1mmHg of IOP change. A possible implementation using a contoured facial mask is also presented.

Constitutive Behavior of Ocular Tissues Over a Range of Strain Rates

The constitutive behavior of bovine scleral and corneal tissues is measured in tension and compression, at quasi-static and moderate strain rates. Experiments are conducted at strain rates up to about 50 strain per second by a pneumatic testing system developed to overcome noise and measurement difficulties associated with the time dependent test of low impedance materials. Results for the tissues at room and the natural bovine body temperatures are similar and indicate that ocular tissue exhibits nonlinear stiffening for increasing strain rates, a phenomena termed rate hardening. For example, at a tensile strain rate of 29/s, corneal tissue is found to develop 10 times the stress that it does quasi-statically at the same strain. Thus, conventional constitutive models will grossly underpredict stresses occurring in the corneo-scleral shell due to moderate dynamic events. This has implication to the accuracy of ocular injury models, the study of the stress field in the corneo-scleral shell for glaucoma research and tonometry measurements. The measured data at various strain rates is represented using the general framework of a constitutive model that has been used to represent biological tissue mechanical data. Here it is extended to represent the measured data of the ocular tissues over the range of tested strain rates. Its form allows for straightforward incorporation in various numerical codes. The experimental and analytical methods developed here are felt to be applicable to the test of human ocular tissue.

Biomechanical modeling of eye trauma for different orbit anthropometries

In military, automotive, and sporting safety, there is concern over eye protection and the effects of facial anthropometry differences on risk of eye injury. The objective of this study is to investigate differences in orbital geometry and analyze their effect on eye impact injury. Clinical measurements of the orbital aperture, brow protrusion angle, eye protrusion, and the eye location within the orbit were used to develop a matrix of simulations. A finite element (FE) model of the orbit was developed from a computed tomography (CT) scan of an average male and transformed to model 27 different anthropometries. Impacts were modeled using an eye model incorporating lagrangian–eulerian fluid flow for the eye, representing a full eye for evaluation of omnidirectional impact and interaction with the orbit. Computational simulations of a Little League (CD25) baseball impact at 30.1 m/s were conducted to assess the effect of orbit anthropometry on eye injury metrics. Parameters measured include stress and strain in the corneoscleral shell, internal dynamic eye pressure, and contact forces between the orbit, eye, and baseball. The location of peak stresses and strains was also assessed. Main effects and interaction effects identified in the statistical analysis illustrate the complex relationship between the anthropometric variation and eye response. The results of the study showed that the eye is more protected from impact with smaller orbital apertures, more brow protrusion, and less eye protrusion, provided that the orbital aperture is large enough to deter contact of the eye with the orbit.

Finite element modeling of the human sclera: Influence on optic nerve head biomechanics and connections with glaucoma

Scleral thickness, especially near the optic nerve head (ONH), is a potential factor of interest in the development of glaucomatous optic neuropathy. Large differences in the dimensions of the sclera, the principal load-bearing tissue of the eye, have been observed between individuals. This study aimed to characterize the effects of these differences on ONH biomechanics. Eleven enucleated human globes (7 normal and 4 ostensibly glaucomatous) were imaged using high-field microMRI and segmented to produce 3-D individual-specific corneoscleral shells. An identical, idealized ONH geometry was inserted into each shell. Finite element modeling predicted the effects of pressurizing the eyes to an IOP of 30 mmHg, with the results used to characterize the effect of inter-individual differences in scleral dimensions on the biomechanics of the ONH. Measurements of the individual-specific corneoscleral shells were used to construct a 2-D axisymmetric idealized model of the corneoscleral shell and ONH. A sensitivity analysis based on this model quantified the relative importance of different geometrical characteristics of the scleral shell on the biomechanics of the ONH. Significant variations were observed in various measures of strain in the idealized lamina cribrosa (LC) across the seven normal corneoscleral shells, implying large differences in individual biomechanics due to scleral anatomy variations alone. The sensitivity analysis revealed that scleral thickness adjacent to the ONH was responsible for the vast majority of variation. Remarkably, varying peripapilary scleral thickness over the physiologically measured range changed the peak (95th percentile) first principal strain in the LC and radial displacement of the ONH canal by an amount that was equivalent to a change in IOP of 15 mmHg. Inter-individual variations in scleral thickness, particularly peripapillary scleral thickness, can result in vastly different biomechanical responses to IOP. These differences may be significant for understanding the interactions between IOP and scleral biomechanics in the pathogenesis of glaucomatous optic neuropathy. The relationship between scleral thickness and material properties needs to be studied in human eyes.

MR elastography of the ex vivo bovine globe.

To evaluate the feasibility of using MR elastography (MRE) to assess the mechanical properties of the eye. The elastic properties of the corneoscleral shell of an intact, enucleated bovine globe specimen were estimated using MRE and finite element modeling (FEM), assuming linear, isotropic behavior. The two-dimensional (2D), axisymetric model geometry was derived from a segmented 2D MR image, and estimations of the Young's modulus in both the cornea and sclera were made at various intraocular pressures using an iterative flexural wave speed matching algorithm. Estimated values of the Young's moduli of the cornea and sclera varied from 40 to 185 kPa and 1 to 7 MPa, respectively, over an intraocular pressure range of 0.85 to 9.05 mmHg (1.2 to 12.3 cmH(2)O). They also varied exponentially as functions of both wave speed and intraocular dP/dV, an empirical measure of "ocular rigidity." These results show that it is possible to estimate the intrinsic elastic properties of the corneoscleral shell in an ex vivo bovine globe, suggesting that MRE may provide a useful means to assess the mechanical properties of the eye and its anatomy. Further development of the technique and modeling process will enhance its potential, and further investigations are needed to determine its clinical potential.

Dimensions of the human sclera: Thickness measurement and regional changes with axial length

Scleral thickness, especially near the region of the optic nerve head (ONH), is a potential factor of interest in the development of glaucomatous optic neuropathy. Our goal was to characterize the scleral thickness distribution and other geometric features of human eyes. Eleven enucleated human globes (7 normal and 4 ostensibly glaucomatous) were imaged using high-field microMRI, providing 80 μm isotropic resolution over the whole eye. The MRI scans were segmented to produce 3-D corneoscleral shells. Each shell was divided into 15 slices along the anterior–posterior axis of the eye, and each slice was further subdivided into the anatomical quadrants. Average thickness was measured in each region, producing 60 thickness measurements per eye. Hierarchical clustering was used to identify trends in the thickness distribution, and scleral geometric features were correlated with globe axial length. Thickness over the whole sclera was 670 ± 80 μm (mean ± SD; range: 564 μm–832 μm) over the 11 eyes. Maximum thickness occurred at the posterior pole of the eye, with mean thickness of 996 ± 181 μm. Thickness decreased to a minimum at the equator, where a mean thickness of 491 ± 91 μm was measured. Eyes with a reported history of glaucoma were found to have longer axial length, smaller ONH canal dimensions and thinner posterior sclera. Several geometrical parameters of the eye, including posterior scleral thickness, axial length, and ONH canal diameter, appear linked. Significant intra-individual and inter-individual variation in scleral thickness was evident. This may be indicative of inter-individual differences in ocular biomechanics.

A computational remodeling approach to predict the physiological architecture of the collagen fibril network in corneo-scleral shells

Organized collagen fibrils form complex networks that introduce strong anisotropic and highly nonlinear attributes into the constitutive response of human eye tissues. Physiological adaptation of the collagen network and the mechanical condition within biological tissues are complex and mutually dependent phenomena. In this contribution, a computational model is presented to investigate the interaction between the collagen fibril architecture and mechanical loading conditions in the corneo-scleral shell. The biomechanical properties of eye tissues are derived from the single crimped fibril at the micro-scale via the collagen network of distributed fibrils at the meso-scale to the incompressible and anisotropic soft tissue at the macro-scale. Biomechanically induced remodeling of the collagen network is captured on the meso-scale by allowing for a continuous re-orientation of preferred fibril orientations and a continuous adaptation of the fibril dispersion. The presented approach is applied to a numerical human eye model considering the cornea and sclera. The predicted fibril morphology correlates well with experimental observations from X-ray scattering data.

Sensitivity of applanation tonometry readings to the geometrical parameters of the sclera and the shape of the cornea

Abstract Purpose To study the effect of the geometrical parameters of a cornea (the thickness and difference of corneal shape from spherical segment) on applanation tonometry readings. Methods The mathematical model for Goldmann and Maklakov tonometers is developed. The corneoscleral shell is modeled as two conjugated transversal isotropic elliptic (with non‐zero eccentricity) shells (cornea and sclera) with different mechanical properties. The baseline (prior to loading) two‐segment shell is assumed to be filled with incompressible liquid under pressure. Simulated IOP measurements are obtained for Goldman and 5‐g and 10‐g Maklakov tonometers. To analyze the effect of the eyeball geometry on IOP readings the elastic constants of cornea and sclera are varied and geometrical parameters (such as central corneal thickness, cornea and sclera radii of curvature, scleral thickness, ratio of anterior‐posterior eye axis lengths vs. the equator diameter) are varied. Simulated calculations are compared with experimental data. Results The results are obtained over a wide range of parameters of the sclera and cornea. Conclusion If the shape of a cornea differs from spherical it could cause the measurement error of tonometry IOP readings ranged between 3% and 25%. Significant sensitivity of the Goldmann tonometer to corneal thickness compared to Maklakov's method may be explained with smaller contact zone and, hence, the larger influence of the flexural (bending) deformation, which depends on the thickness of a shell. Contrariwise the change of the radius of curvature of cornea affects greatly on the results obtained with Maklakov tonometer.

Why do we need a biomechanical approach to the ocular rigidity concept?

AbstractOcular rigidity in ophthalmology is generally assumed to be a measurable surrogate parameter related to the biomechanical properties of the whole globe. Clinical tonometry and tonography, as well as recently developed methods to assess the ocular pulse amplitude and pulsatile ocular blood flow and measurements with the ocular response analyzer are based on the concept of ocular rigidity. Clinical concepts of ocular rigidity describe a resulting effect without considerations of possible diverse morphology and material properties of the different ocular tissues. It is commonly accepted that ocular rigidity is related to the elasticity of the sclera. Many formulations are however dependent on the internal volume of the globe, intraocular pressure, corneal biomechanics and thickness of the corneoscleral shell. Sometimes this is extended to biomechanical properties of the ocular vasculature and perfusion pressure. Therefore ocular rigidity is expressed in various units and has different physical meanings but the same name is used which is confusing. Ocular biomechanics introduces parameters of elasticity and viscoelasticity of the sclera, cornea and other tissues which consider the morphology of the different tissues describing their mechanical properties such as: Young’s modules of the sclera and Poisson’s ratios of the cornea. When applying these rigorous statements and methods of biomechanical modeling a unified concept for ocular rigidity can be developed in order to link the limited clinical concepts, to improve them and to better understand the results of clinical measurements.

Mathematical models of intraocular pressure measurements and ocular rigidity

AbstractThe term ocular rigidity is widely used in ophthalmology. Generally it is assumed as a measurable physical parameter related to biomechanical properties of the whole eye globe. Formulas for clinical tonometry and tonography methods include the concept of ocular rigidity. Unfortunately ocular rigidity represents an elusive concept that means many things to many people. First of all, there is no consensual view on ocular rigidity in ophthalmology. The most of the formulas for ocular rigidity are based on discrete or continuous tonometric measurements in living or enucleated human eyes. Surprisingly ocular rigidity is measured in different units and has a different meaning by different authors. Finally, there is no clear consent between biomechanical engineers and ophthalmologists on the concept of ocular rigidity. In biomechanics parameters for the elasticity and viscoelasticity are accepted, which represent mechanical properties of a tissue an can consider its morphology. These are for example: Young’s moduli of the sclera, Poisson’s ratios of the cornea etc. Ophthalmological concepts on ocular rigidity are based on the consideration, that biomechanical properties of the corneoscleral shell are involved in the pressure‐volume relationship of the eye globe. Ocular rigidity defined in such a way climes to describe the total response of the eye without detailed considerations on its morphologic and material properties. In the proposed review several formulations of ocular rigidity are analysed and classified. It is attempted to link these conceptions with each other.

In-plane mechanics of the optic nerve head with cellular solids models

Scleral thickness, especially near the optic nerve head (ONH), is a potential factor of interest in the development of glaucomatous optic neuropathy. Large differences in the dimensions of the sclera, the principal load-bearing tissue of the eye, have been observed between individuals. This study aimed to characterize the effects of these differences on ONH biomechanics. Eleven enucleated human globes (7 normal and 4 ostensibly glaucomatous) were imaged using high-field microMRI and segmented to produce 3-D individual-specific corneoscleral shells. An identical, idealized ONH geometry was inserted into each shell. Finite element modeling predicted the effects of pressurizing the eyes to an IOP of 30 mmHg, with the results used to characterize the effect of inter-individual differences in scleral dimensions on the biomechanics of the ONH. Measurements of the individual-specific corneoscleral shells were used to construct a 2-D axisymmetric idealized model of the corneoscleral shell and ONH. A sensitivity analysis based on this model quantified the relative importance of different geometrical characteristics of the scleral shell on the biomechanics of the ONH. Significant variations were observed in various measures of strain in the idealized lamina cribrosa (LC) across the seven normal corneoscleral shells, implying large differences in individual biomechanics due to scleral anatomy variations alone. The sensitivity analysis revealed that scleral thickness adjacent to the ONH was responsible for the vast majority of variation. Remarkably, varying peripapilary scleral thickness over the physiologically measured range changed the peak (95th percentile) first principal strain in the LC and radial displacement of the ONH canal by an amount that was equivalent to a change in IOP of 15 mmHg. Inter-individual variations in scleral thickness, particularly peripapillary scleral thickness, can result in vastly different biomechanical responses to IOP. These differences may be significant for understanding the interactions between IOP and scleral biomechanics in the pathogenesis of glaucomatous optic neuropathy. The relationship between scleral thickness and material properties needs to be studied in human eyes.

Prótese intra-ocular de resina acrílica em cães e gatos

Foram atendidos no Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Unesp - Campus de Botucatu, 11 animais (oito cães e três gatos), com alterações oftálmicas unilaterais graves que levaram à perda total da função ocular (protrusão de globo com injúria nervosa e estrutural, perfurações de córnea com perda de conteúdo intra-ocular e endoftalmites, entre outras). Os animais, com idades entre dois meses e 10 anos, foram submetidos à evisceração e posterior inclusão de esfera de resina acrílica (metilmetacrilato) na capa córneo-escleral ou escleral. As esferas foram previamente confeccionadas e esterilizadas por autoclavagem. No pós-operatório foram utilizados antiinflamatórios e antibioticoterapia tópica combinada ou não a sistêmica. O período de observação variou de 2 meses a 3 anos e os aspectos avaliados foram secreção ocular, blefarospasmo, sinais de desconforto e estética. Obtiveram-se resultados satisfatórios em oito casos. Concluiu-se que a resina acrílica pode ser uma alternativa para uso como inclusão em cavidade anoftálmica.

A New Scleral Suction Trephine for Retrieval of Corneoscleral Donor Tissue

Removal of donor corneo-scleral shell from a cadaver, leaving the remainder of the eye in place, has become a popular technique. Manual removal can result in excessive trauma to the corneal endothelium or an uneven scleral rim. We describe a new technique for corneal retrieval using a sceral suction trephine. The scleral suction trephine was cut evenly in our eyebank study. There was no additional trauma to the endothelium and the scleral rim was regular. Suction trephination of the sclera in retrieval of corneal donor tissue appears to be safe and effective.

Cell kinetics of normal and healing rat corneal epithelium during organ culture.

Local epithelial proliferation in corneal, limbal, and conjunctival rat epithelium was investigated during organ culture of corneo-scleral shells, by relating the number of tritium labelled cells to the total number of cells (labelling index). The changes in labelling index after a mechanically induced central corneal abrasion were also studied. Local labelling indices were measured 2 h, 1, 2, 4 and 7 days after incubation. The average labelling index increased in un-abraded specimens 4-fold after 4 days of incubation, while the total number of cells only decreased 30-50%. In eyes with a central corneal abrasion the labelling index increased 10-fold in the surrounding epithelial cells after 1 day. The labelling index of the limbal and conjunctival epithelial cells increased to the same extent after 2 days of incubation. The finding of a reduced total number of cells and an increased cell proliferation in un-abraded eyes may be explained by increased loss of mature cells normally producing growth-inhibitory substances (chalones). Alternatively, the culture medium may contain an excess of growth-stimulatory substances. The results also suggest that the proliferative response spreads in a centrifugal direction during in vitro healing of a central corneal abrasion.

A fluid-structure interaction problem in biomechanics: Prestressed vibrations of the eye by the finite element method

The object of this work has been to develop a mechanical and numerical model of the eye submitted to vibrations, and in particular, to calculate the influence of intraocular pressure (IOP) on the eye resonance frequencies. Our mechanical model of the eye relies upon the theory of the mechanics of continuous media. The numerical model results from a modal analysis of the vibrations of the eye using a finite element method (FEM) for discretization. The eye can be schematically represented as a prestressed shell, filled by an inviscid barotropic compressible fluid, which leads us to formulate and solve a problem of vibrations of a coupled fluid-structure system. The corneoscleral shell has been modeled as a thin and thick shell, taking into account material nonlinearities in the thick case. Numerical results obtained for the attached eye demonstrate a fair sensitivity of the resonance frequencies to the variations of the IOP; thus, founding the interest of the surveillance of the resonance frequency of the eye.

Computer Simulation of Arcuate Keratotomy for Astigmatism

The development of refractive corneal surgery involves numerous attempts to isolate the effect of individual factors on surgical outcome. Computer simulation of refractive keratotomy allows the surgeon to alter variables of the technique and to isolate the effect of specific factors independent of other factors, something that cannot easily be done in any of the currently available experimental models. We used the finite element numerical method to construct a mathematical model of the eye. The model analyzed stress-strain relationships in the normal corneoscleral shell and after astigmatic surgery. The model made the following assumptions: an axisymmetric eye, an idealized aspheric anterior corneal surface, transversal isotropy of the cornea, nonlinear strain tensor for large displacements, and near incompressibility of the corneoscleral shell. The eye was assumed to be fixed at the level of the optic nerve. The model described the acute elastic response of the eye to corneal surgery. We analyzed the effect of paired transverse arcuate corneal incisions for the correction of astigmatism. We evaluated the following incision variables and their effect on change in curvature of the incised and unincised meridians: length (longer, more steepening of unincised meridian), distance from the center of the cornea (farther, less flattening of incised meridian), depth (deeper, more effect), and the initial amount of astigmatism (small effect). Our finite element computer model gives reasonably accurate information about the relative effects of different surgical variables, and demonstrates the feasibility of using nonlinear, anisotropic assumptions in the construction of such a computer model. Comparison of these computer-generated results to clinically achieved results may help refine the computer model.

Outflow facility studies in the perfused human ocular anterior segment

We have recently developed a tissue model of the human aqueous outflow pathway involving placement of the eviscerated anterior corneoscleral shell, [with lens and uveal tissue removed but trabecular meshwork (TM) attached] onto a specialized perfusion apparatus. The TM and associated outflow tissues are perfused with culture medium at a physiologically-relevant perfusion pressure in a 5% CO 2 environment at 37°C. Under these conditions, the perfused outflow tissues are similar for several days, to the human and/or subhuman primate outflow system in vivo with regard to morphology as well as several functional parameters. Measured facility of outflow (0·271±0·018 μl min −1 mmHg −1, n = 79) is similar to facility values obtained by tonography in living human beings. Moreover, outflow facility decreases in a linear fashion with increased perfusion pressure by 1·4% mmHg −1. Finally the removal of the TM results in a 41% decrease in measured outflow resistance. The ability to study viable human outflow tissue for at least several days and the opportunity to establish a model which serves as an alternative to animal testing, point to the potential importance of this technique in investigating the biology of the aqueous outflow system.

The Hanna suction punch block and trephine system for penetrating keratoplasty.

We describe a new system for corneal trephination. The system for cutting donor buttons consists of a concave Teflon well in which the donor corneoscleral shell is secured by gentle suction. A cylindrical guide ensures that the disposable razor blade trephine is centered and is perpendicular during punching from the endothelium. The suction mechanical trephine used for the host has the following features: (1) a gun-sight alignment system for reliable centering, (2) a 360 degrees limbal suction ring that secures the trephine to the eye and ensures perpendicularity of the cut, (3) support surfaces on either side of the disposable razor blade that support the cornea during cutting to create near-vertical uniform wound margins, (4) rotation of the trephine with a manually operated gear system for smooth cutting, and (5) a calibration device that governs the extension of the blade and also allows cutting without descent of the blade.