Okamura Kanno, Shimokawa Asami, Takahashi Rie, Saeki Yusuke, Ozaki Hiroaki, Uchio Eiichi
Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan.
Clin Ophthalmol. 2020 Jan 21;14:179-186. doi: 10.2147/OPTH.S236825. eCollection 2020.
Due to the mechanical vulnerability of eyes that have undergone penetrating keratoplasty (PKP), it is clinically important to evaluate the possibility of corneal wound dehiscence by blunt impact. We have previously developed a simulation model resembling a human eye based on information obtained from cadaver eyes and applied three-dimensional finite element analysis (FEA) to determine the physical and mechanical response to an air gun impact at various velocities on the post-PKP eye.
Simulations in a human eye model were performed with a computer using a FEA program created by Nihon, ESI Group. The air gun pellet was set to impact the eye at three-different velocities in straight or 12° up-gaze positions with the addition of variation in keratoplasty suture strength of 30%, 50% and 100% of normal corneal strength.
Furthermore to little damage in the case of 100% strength, in cases of lower strength in a straight-gaze position, wound rupture seemed to occur in the early phase (0.04-0.06 ms) of impact at low velocities, while regional break was observed at 0.14 ms after an impact at high velocity (75 m/s). In contrast, wound damage was observed in the lower quadrant of the suture zone and sclera in 12° up-gaze cases. Wound damage was observed 0.08 ms after an impact threatening corneoscleral laceration, and the involved area being larger in middle impact velocity (60 m/s) simulations than in lower impact velocity simulations, and larger damaged area was observed in high impact velocity cases and leading to corneoscleral laceration.
These results suggest that the eye is most susceptible to corneal damage around the suture area especially with a straight-gaze impact by an air gun, and that special precautionary measures should be considered in patients who undergo PKP. FEA using a human eyeball model might be a useful method to analyze and predict the mechanical features of eyes that undergo keratoplasty.
由于穿透性角膜移植术(PKP)后的眼睛存在机械脆弱性,评估钝性撞击导致角膜伤口裂开的可能性在临床上具有重要意义。我们之前基于从尸体眼睛获得的信息开发了一种类似人眼的模拟模型,并应用三维有限元分析(FEA)来确定PKP术后眼睛在不同速度下受到气枪撞击时的物理和机械反应。
使用日本ESI集团创建的FEA程序在计算机上对人眼模型进行模拟。气枪弹丸设置为以三种不同速度在直视或向上注视12°位置撞击眼睛,并增加角膜移植缝线强度分别为正常角膜强度的30%、50%和100%的变化。
此外,在强度为100%的情况下损伤较小,在直视位置强度较低的情况下,低速撞击时伤口破裂似乎发生在撞击的早期阶段(0.04 - 0.06毫秒),而高速(75米/秒)撞击后0.14毫秒观察到局部破裂。相比之下,在向上注视12°的情况下,在缝线区域和巩膜的下象限观察到伤口损伤。在威胁到角巩膜撕裂的撞击后0.08毫秒观察到伤口损伤,并且在中等撞击速度(60米/秒)模拟中的受累区域比低撞击速度模拟中的更大,在高撞击速度情况下观察到更大的损伤区域并导致角巩膜撕裂。
这些结果表明,眼睛在缝线区域周围最易受到角膜损伤,尤其是气枪直视撞击时,并且对于接受PKP的患者应考虑采取特殊的预防措施。使用人眼球模型的FEA可能是分析和预测接受角膜移植术眼睛机械特征的有用方法。