Abstract:
This study presents a patient-specific, three-dimensional finite element framework to simulate keratoconus (KC) progression and the biomechanical effects of corneal collagen cross-linking (CXL). Using clinical tomography and intraocular pressure measurements, regional hyperelastic elastic-modulus reductions (10–45%) and focal thickness adjustments were imposed to replicate asymmetric KC topography. Simulations demonstrated that progressive focal weakening alone can recreate characteristic cone steepening and higher-order aberrations without corneal thinning. Standard broad-beam CXL protocols (9 mm diameter; 200 μm and 300 μm depths) produced 24–34% greater flattening and 22–31% lower aberrations with deeper stiffening, while alternative variable-intensity and cone-centered CXL patterns yielded even more pronounced, spatially localized flattening. Outcomes were sensitive to IOP and stiffening distribution relative to cone location. These biomechanics-driven insights underscore the central role of hyperelastic material properties and spatial stiffening strategies in KC management and CXL optimization.
