Journal of Healthcare Engineering

Journal of Healthcare Engineering / 2010 / Article

Research Article | Open Access

Volume 1 |Article ID 743146 |

Elena Lanchares, Begoña Calvo, María A. del Buey, José A. Cristóbal, Manuel Doblaré, "The Effect of Intraocular Pressure on the Outcome of Myopic Photorefractive Keratectomy: A Numerical Approach", Journal of Healthcare Engineering, vol. 1, Article ID 743146, 16 pages, 2010.

The Effect of Intraocular Pressure on the Outcome of Myopic Photorefractive Keratectomy: A Numerical Approach


Photorefractive Keratectomy (PRK) is a surgical procedure widely performed to correct myopia. In this work, the effect of the intraocular pressure (IOP) on the refractive correction achieved by the PRK surgery was analyzed using a numerical model. Simulations of PRK surgery at 10, 15 and 21 mmHg of IOP were performed and the post-surgical diopters were estimated. For low and medium values of IOP (10 and 15 mmHg), the computed results were close to those used by clinicians based on experience and defined without considering the IOP, while an undercorrection was predicted for the highest value of IOP (21 mmHg). From these results, we suggest that IOP should be considered in the determination of the depth of ablation, in addition to other factors such as the level of myopia or the corneal central thickness.


  1. J. D. Doughty and M. L. Zaman, “Human corneal thickness and its impact on intraocular pressure measures: a review and meta-analysis approach,” Surv. Ophthalmol, vol. 44, no. 5, pp. 367–408, 2000. View at: Google Scholar
  2. A. Elsheikh, D. Alhasso, and P. Rama, “Assessment of the epithelium's contribution to corneal biomechanics,” Experimental Eye Research, vol. 86, pp. 445–451, 2008. View at: Google Scholar
  3. C. S. Foster, D. T. Azar, and C. H. Dohlman, The Cornea. Scientific Foundations & Clinical Practice, Lippincott Williams & Wilkins, Philadelphia, USA, 2005.
  4. R. H. Newton and K. M. Meek, “The Integration of the Corneal and Limbal Fibers in the Human Eye,” Biophys J, vol. 75, pp. 2508–2512, 1998. View at: Google Scholar
  5. J. I. Barraquer, “Conducta de la córnea frente a los cambios de espesor (contribución a la cirugía refractiva),” Arch Soc Am Oftalmol Optom, vol. 5, pp. 81–87, 1964. View at: Google Scholar
  6. S. Trokel, R. Srinivasan, and B. Braren, “Excimer Laser Surgery of the Cornea,” American Journal of Ophthalmology, vol. 96, pp. 710–715, 1983. View at: Google Scholar
  7. P. S. Hersh, K. S. Scher, and R. Irani, “Corneal topography of photorefractive keratectomy versus laser in situ keratomileusis. Summit PRK-LASIK study Group,” Ophtalmology, vol. 105, pp. 612–619, 1998. View at: Google Scholar
  8. F. J. Potgieter, C. Roberts, I. G. Cox et al., “Prediction of flap response,” J Cataract Refract Surg., vol. 31, no. 1, pp. 106–14, 2005 Jan. View at: Google Scholar
  9. M. Bryant and P. McDonnell, “Constitutive laws for biomechanical modeling of refractive surgery,” J Biomech Eng, vol. 118, pp. 473–481, 1996. View at: Google Scholar
  10. D. Cabrera Fernández, A. M. Niazy, R. M. Kurtz, G. P. Djotyan, and T. Juhasz, “Finite element analysis applied to cornea reshaping,” J Biomed Opt., vol. 10, no. 6, 064018, 2005 Nov-Dec. View at: Google Scholar
  11. A. Gefen, R. Shalom, D. Elad, and Y. Mandel, “Biomechanical analysis of the keratoconic cornea,” J. Mech. Behav. Biomed. Mater., vol. 2, no. 3, pp. 224–236, 2009. View at: Google Scholar
  12. A. Pandolfi, G. Fotia, and F. Manganiello, “Element Simulations of Laser Refractive Corneal Surgery,” Engineering with Computers, vol. 25, pp. 15–24, 2009. View at: Google Scholar
  13. P. Pinsky, D. V. D. Heide, and D. Chernyak, “Computational modeling of mechanical anisotropy in the cornea and sclera,” J Cataract Refract Surg, vol. 31, pp. 136–145, 2005. View at: Google Scholar
  14. V. Alastrué, B. Calvo, E. Peña, and M. Doblaré, “Biomechanical Modelling of Refractive Corneal surgery,” J Biomech Eng ASME, vol. 128, no. 1, pp. 150–160, 2006. View at: Google Scholar
  15. A. Pandolfi and F. Maganiello, “A model for the human cornea: constitutive formulation and numerical analysis,” Biomech Model Mechanobiol, vol. 5, pp. 237–246, 2006. View at: Google Scholar
  16. P. Pinsky and V. Datye, “A microstructurally-based finite element model of the incised human cornea,” Journal of Biomedical Engineering, vol. 10, pp. 907–922, 1991. View at: Google Scholar
  17. E. Lanchares, B. Calvo, J. A. Cristóbal, and M. Doblaré, “Finite Element simulation of arcuates for astigmatism correction,” J Biomech., vol. 41, no. 4, pp. 797–805, 2008. View at: Google Scholar
  18. K. Anderson, A. El-Sheikh, and T. Newson, “Application of structural analysis to the mechanical behaviour of the cornea,” J R Soc Interface, vol. 1, no. 1, pp. 3–15, 2004; 22. View at: Google Scholar
  19. T. Colton and F. Ederer, “The distribution of intraocular pressures in the general population,” Survey of Ophthalmology, vol. 25, no. 3, pp. 123–129, 1980. View at: Google Scholar
  20. D. Cabrera Fernández, A. M. Niazy, R. M. Kurtz, G. P. Djotyan, and T. Juhasz, “A finite element model for ultrafast laser-lamellar keratoplasty,” Ann Biomed Eng, vol. 34, pp. 169–183, 2006. View at: Google Scholar
  21. Computational Modeling Sciences Department, Sandia National Laboratories. Cubit 10.1 User Documentation., 2006.
  22. Structural Dynamics Research Corporation. I-Deas Tutorials. EDS. 2001.
  23. D. Hoeltzel, P. Altman, D. Buzard, and K. Choe, “Strip extensometry for comparison of the mechanical response of bovine, rabbit and human corneas,” J Biomech Eng, vol. 114, pp. 202–215, 1992. View at: Google Scholar
  24. D. Monti, P. Chetoni, S. Burgalassi, M. Najarro, and M. F. Saettone, “Increased corneal hydration induced by potential ocular penetration enhancers: assessment by differential scanning calorimetry (DSC) and by desiccation,” International Journal of Pharmaceutics, vol. 232, no. 1-2, pp. 139–147, 2002. View at: Google Scholar
  25. H. Aghamohammadzadeh, R. H. Newton, and K. M. Meek, “X-ray scattering used to map the preferred collagen orientation in the human cornea and limbus,” Structure, vol. 12, pp. 249–256, 2004. View at: Google Scholar
  26. G. A. Holzapfel and T. Gasser, “A viscoelastic model for fibre-reinforced composites at finite strains: Continuum basis, computational aspects and applications,” Comput Methods Appl Mech Engrg, vol. 190, pp. 4379–4403, 2001. View at: Google Scholar
  27. J. Weiss, B. Maker, and S. Govindjee, “Finite element implementation of incompressible, transversely isotropic hyperelasticity,” Comput Methods Appl Mech Engrg, vol. 135, pp. 107–128, 1996. View at: Google Scholar
  28. J. C. Simo and R. L. Taylor, “Consistent tangent operators for rate-independent elastoplasticity,” Comput Methods Appl Mech Engrg, vol. 48, pp. 101–118, 1985. View at: Google Scholar
  29. G. A. Holzapfel, T. C. Gasser, and R. W. Ogden, “A new constitutive framework for arterial wall mechanics and a comparative study of material models,” J Elasticity, vol. 61, pp. 1–48, 2000. View at: Google Scholar
  30. J. Gardiner and J. Weiss, “Subject-specific finite element analysis of the human medial collateral ligament during valgus knee loading,” J Orthopaed Res, vol. 21, pp. 1098–1106, 2003. View at: Google Scholar
  31. K. A. Buzard, “Introduction to biomechanics of the cornea,” Refract Corneal Surg, vol. 8, pp. 127–138, 1992. View at: Google Scholar
  32. C. Munnerlyn, S. J. Koons, and J. Marshall, “Photorefractive keratectomy: a technique for laser refractive surgery,” J Cataract Refract Surg, vol. 14, pp. 46–52, 1988. View at: Google Scholar
  33. Hobbit, Karlsson and Sorensen, Inc., Abaqus user's guide, v. 5.8., HKS inc., Pawtucket, RI, USA, 1999.
  34. R. S. Kalski, G. Sutton, Y. Bin, M. A. Lawless, and C. Rogers, “Comparison of 5-mm and 6-mm ablation zones in photorefractive keratectomy for myopia,” Journal of Refractive Surgery, vol. 12, no. 1, pp. 61–67, 1996. View at: Google Scholar
  35. M. S. Rajan, D. O'Brart, P. Jaycock, and J. Marshall, “Effects of Ablation Diameter on Long-term Refractive Stability and Corneal Transparency after Photorefractive Keratectomy,” Ophthalmology, vol. 113, pp. 1798–1806, 2006. View at: Google Scholar
  36. Bausch & Lomb, Orbscan II Anterior Segment Analysis System. Operator's Manual, Orbtek Inc., Salt Lake City, UT, USA, 2003.
  37. H. Studer, X. Larrea, H. Riedwyl, and P. Buechler, Biomechanical model of human cornea based on stromal microstructure. J Biomech 2009. doi:10.1016/j.jbiomech.2009.11.021. In press.
  38. R. Navarro, L. González, and J. L. Hernández, “Optics of the average normal cornea from general and canonical representations of its surface topography,” J Opt Soc Am A, vol. 23, pp. 219–232, 2006. View at: Google Scholar

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