Consideration of corneal biomechanics in the diagnosis and management of keratoconus: is it important?

Keratoconus is a bilateral,non-inflammatory,degenerative corneal disease.The occurrence and development of keratoconus is associated with corneal thinning and conical protrusion,which causes irregular astigmatism.With the disruption of the collagen organization,the cornea loses its shape and function resulting in progressive visual degradation.Currently,corneal topography is the most important tool for the diagnosis of keratoconus,which may lead to false negatives among the patient population in the subclinical phase.However,it is now hypothesised that biomechanical destabilisation of the cornea may take place ahead of the topographic evidence of keratoconus,hence possibly assisting with disease diagnosis and management.This article provides a review of the definition,diagnosis,and management strategies for keratoconus based on corneal biomechanics.

High intercorneal symmetry in corneal biomechanical metrics

Backgroud:To evaluate the symmetry of corneal biomechanical metrics,measured using an ocular response analyzer(ORA)and self-built corneal inflation test platform,in bilateral rabbit corneas and to investigate their relationship with physical intraocular pressure(IOPp).Methods:Twenty fresh enucleated eyes from ten rabbits were used for ex vivo whole ocular globe inflation.IOP was increased from 7.5 to 37.5 mmHg with 7.5 mmHg steps and biomechanical metrics were acquired using the ORA.At least 3 examinations were performed at each pressure stage.Two biomechanical metrics,corneal hysteresis(CH)and corneal resistance factor(CRF)were recorded and analyzed as a function of IOPp.Corneal specimens were then excised from the intact ocular globe and tested under inflation conditions up to 45.7 mmHg posterior pressure.The experimental pressure-deformation data was analyzed using an inverse modeling procedure to derive the stress-strain behavior of the cornea.Results:A comparison of corneal shape parameters showed no statistically significant difference(P>0.05)between bilateral eyes.Similarly,there were no statistically significant differences in values of CH,CRF and corneal stiffness(as measured by the tangent modulus,Et)between bilateral eyes(CH:F=0.94,P=0.54;CRF:F=4.42,P=0.35;Et:F=3.15,P=0.12)at different pressure levels.IOPp was highly correlated with CRF while the relationship with CH was less pronounced.Conclusions:An obvious interocular symmetry in biomechanical metrics is found in this research.IOP has been shown to have important influences on the value of CRF provided by ORA.