Streamlined approach to corneal ring implantation based on mathematical modeling
E.G. Solodkova, S.B. Izmailova, I.N. Zakharov, V.P. Fokin, S.V. Balalin, E.V. Lobanov, V.A. Sivolobov, V.H. Le
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Published: Jan 1, 2025
DOI: 10.32364/2311-7729-2025-25-suppl-1
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Aim: to analyze results of application of personalized approach to implantation of intracorneal rings (ICR). The technique is based on tailored choice of their size and position, as well as prediction of progressive keratoconus surgery outcomes using a mathematical model of a particular patient's cornea. Patients and Methods: biomechanical properties of the cornea with keratoconus under external diagnostic procedures were simulated by COMSOL Multiphysics® software. According to the finite element method, three-dimensional images demonstrating distribution of tension and deformity intensities throughout the cornea were obtained. As a result of their comparison with the basic topographic and tomographic maps (Pentacam AXL) along with Corvis ST data (OCULUS Optikgeräte GmbH, Germany), localization, dimensions and severity of deterioration of biomechanical properties of weakened corneal areas were determined. A "digital twin" of the cornea was plotted to select the best option of the ICR's size and position. A scheduled position of the corneal tunnel was achieved by automatic marking on the cornea with an excimer laser. Thus, 30 patients (30 eyes) with keratoconus (stages II and III according to Amsler-Krumeich classification) underwent the surgical intervention. Efficacy and safety of the proposed technique were compared with outcomes of the conventional ICR implantation technique as per the Keraring nomogram in 20 patients (20 eyes) with keratoconus (stages II and III). Results: results of digital planning of the surgery coincided with post-surgical outcomes. Efficacy of the proposed approach was confirmed by improved BCVA and UCVA (p<0.001), as well as by decreased Kmax and RMS values (p<0.05) that were more pronounced after the modified technique of ICR implantation. Conclusions: due to modified size and position of a corneal ring, it is possible to control topographic and tomographic corneal characteristics in a flexible way ensuring their best compliance with the target post-surgical parameters. KEYWORDS: keratoconus, intracorneal rings, mathematical model of the cornea. FOR CITATION: Solodkova E.G., Izmailova S.B., Zakharov I.N., Fokin V.P., Balalin S.V., Lobanov E.V., Sivolobov V.A., V.H. Lе. Streamlined approach to corneal ring implantation based on mathematical modeling. Russian Journal of Clinical Ophthalmology. 2025;25(Special Issue):7–18 (in Russ.). DOI: 10.32364/2311-7729-2025-25-Suppl-1
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