Biomechanical study on the edge shapes for penetrating keratoplasty

A parametric study to investigate the compressive and the shear stress distributions for various edge shapes created during penetrating keratoplasty (PK) using femtosecond laser is reported. The finite element analysis has been implemented using ABAQUS to study the cornea with various edge shapes, namely the standard edge shape, the zigzag edge shape, the top hat edge shape and the mushroom edge shape for PK. The ratio of maximum compressive stress to maximum shear stress is used as the main factor to assess the relative merits of wound healing rate for different edge shapes. For the typical values of tissue mechanical properties, the zigzag edge shape has the highest ratio of maximum compressive stress to maximum shear stress (11.1 in the xy-direction and 3.7 in the yz-direction), followed by the mushroom edge shape (7.7 in the xy-direction and 3.2 in the yz-direction). The ratios for the top hat and the standard edge shapes are even lower in both directions. A sensitivity analysis of the model has been done to demonstrate that the zigzag edge shape always results in the highest ratios of stresses regardless of the difference in the tissue mechanical properties. The zigzag edge shape also gives the lowest dioptric power D = 45.4. The present results imply that the zigzag edge shape provides the best wound healing rate and optical outcome among the four edge shapes models for PK.