基于角膜生物力学的SMILE手术参数优化及其联合CXL的效果分析
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中南大学

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Parameter optimization of SMILE and analysis of the surgical effect of CXL based on the corneal mechanical properties
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    摘要:

    目的 建立SMILE手术的有限元模拟体系,模拟术后角膜生物力学性能的变化,为SMILE手术的优化设计提供依据,并探讨CXL手术对SMILE术后角膜的生物力学性能的影响。方法 采用交联强度梯度分布的超弹性本构关系描述角膜的生物力学性能,建立SMILE手术的压痕有限元模型,设置不同的切口位置、切口弧度、侧切口角度和角膜帽厚度,分析SMILE术后角膜生物力学性能的变化;对SMILE术后角膜进行CXL手术的有限元模拟,分析不同辐射能量对角膜生物力学性能的影响。结果 随着切口位置角度的变小、切口弧度增加、侧切口角度从90°增大到135°或减小到45°、角膜帽厚度的减小,SMILE术后角膜的最大Mises应力值不断增大;随着辐射能量增加,CXL术后最大Mises应力值不断增加。结论 构建的有限元模型可有效表征SMILE术后角膜的生物力学性能,为SMILE手术的优化设计提供模拟依据;CXL手术有助于提高SMILE术后角膜的生物力学强度。

    Abstract:

    Objective To establish a finite element simulation system for the surgery of SMILE and provide foundation for the optimization of SMILE based on the simulation results of corneal biomechanical properties, and to study the effect of corneal cross-linking (CXL) on the biomechanical properties of the cornea after SMILE. Method The mechanical behaviors of cornea before and after the surgery were characterized by the hyperelastic constitutive relations with the consideration of gradient distribution of the crosslinking strength. The indentation finite element model of SMILE was established with the Abaqus software. By setting up different surgical parameters such as incision position, incision length, side-cut angle and thickness of corneal cap, the corneal biomechanical behaviors after SMILE were simulated and analyzed. The finite element simulation under different irradiation doses was conducted to analyze the effect of CXL on the cornea after SMILE. Result The maximum value of Mises stress increased as the angle of incision position decreased, the incision length increased, the side-cut angle changed from 90° to 135° or 45°, and the thickness of corneal cap decreased. Moreover, the maximum value of Mises stress after CXL increased with the radiation dose. Conclusion The finite element model of SMILE constructed in this study could effectively be used to characterize the corneal biomechanical properties and provide the simulation reference for the optimization of SMILE. In addition, the reduced corneal biomechanical strength after SMILE could be effectively improved by CXL.

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  • 收稿日期:2022-07-14
  • 最后修改日期:2022-09-17
  • 录用日期:2022-09-19
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