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Customized CXL: from halting of progression to vision rehabilitation

Poster Details

First Author: W.Dupps USA

Co Author(s):    I. Seven   A. Behndig   G. Lytle   S. Herekar   D. Muller        

Abstract Details

Purpose:

To demonstrate the application of a finite element analysis (FEA) to the prediction of clinical outcomes for novel focal illumination corneal cross-linking (CXL).

Setting:

Research Laboratory and University Hospital.

Methods:

Finite element analyses were performed for 4 eyes of 4 patients that underwent CXL treatment with focal illumination patterns. Patient specific FE geometries including epithelium, crosslinked, and non-crosslinked regions of the stroma were meshed using custom meshing software. A hyperelastic, fiber independent, and incompressible material formulation was defined for the stroma. CXL effect was simulated as a stiffening of the corneal shear modulus with an exponential decay in stiffening effect as stromal depth increased, and clinically programmed treatment. The modeling team was masked to the clinical outcomes during the simulation process. Curvature responses for simulated and actual cases were compared.

Results:

Case-specific computational models of focal CXL treatments predicted inferior flattening and superior steepening that favored topographic regularization. The RMS of the mean curvature between simulated cases and unmasked clinical results was 0.08D. Alternative treatment strategies were devised using optimization techniques.

Conclusions:

Case-specific finite element analyses predicted differences in corneal curvature responses to CXL with high fidelity. Optimized treatment patterns produced enhanced optical results in repeat simulations of modeled eyes and have the potential to maximize visual rehabilitation through targeted regularization of corneal curvature. This pilot study demonstrates the potential role of structural modeling in CXL outcome prediction and treatment optimization.

Financial Disclosure:

One or more of the authors gains financially from product or procedure presented, One or more of the authors travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, One or more of the authors research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, One or more of the authors receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, One or more of the authors is employed by a for-profit company with an interest in the subject of the presentation, One or more of the authors has significant investment interest in a company producing, developing or supplying product or procedure presented

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