Predicting the Effects of Customized Corneal Cross-Linking on Corneal Geometry.

Area of Science:

• Ophthalmology
• Biomedical Engineering
• Computational Mechanics

Background:

• Corneal cross-linking (CXL) is a treatment for keratoconus.
• Finite element models (FEM) can simulate biomechanical processes.
• Predicting CXL outcomes requires accurate modeling.

Purpose of the Study:

• Validate an existing FEM for predicting CXL-induced corneal flattening.
• Investigate parameters influencing CXL flattening effects in clinical scenarios.

Main Methods:

• Retrospective analysis of two patient cohorts (standard vs. customized CXL).
• FEM simulation calibrated with experimental data.
• Comparison of FEM predictions with clinical follow-up data.

Main Results:

• Customized CXL resulted in significantly greater corneal flattening (-2.28 D) than standard CXL (-0.81 D).
• FEM predictions showed good correlation with observed curvature changes for both CXL types.
• Sensitivity analysis indicated intraocular pressure and keratoconus severity impact flattening outcomes.

Conclusions:

• Customized CXL achieves approximately 2 diopters of flattening in the corneal cone region.
• The FEM accurately predicts localized curvature correction but has limitations for global metrics.
• CXL-induced flattening is influenced by intraocular pressure, biomechanical weakening, and treatment fluence.