ECCOMAS 2024

Finite Element Simulation of the Pseudophakic Eye

  • Raposo, Bárbara (IDMEC, Instituto Superior Técnico)
  • Ruben, Rui (CDRSP, Instituto Politécnico de Leiria)
  • Ribeiro, Filomena (Ophtalmology Department, Hospital da Luz Lisb)
  • Castro, André (IDMEC, Instituto Superior Técnico)
  • Fernandes, Paulo (IDMEC, Instituto Superior Técnico)

Please login to view abstract download link

Cataracts, characterized by an opacity of the crystalline lens, rank among the leading global causes of blindness. Treatment involves its total removal, followed by the implantation of an intraocular lens (IOL), leaving the eye in a pseudophakic state. Despite the widespread application of this treatment, complications may still occur, most notably posterior chamber IOL dislocation. This often arises from zonular weakness, with pseudoexfoliation being reported as a predisposing factor of in-the-bag IOL dislocation cases. This work aims to comprehend the biomechanical behavior of the human lenticular system before and after cataract surgery, identifying potential factors contributing to late in-the-bag IOL dislocation. A Finite Element (FE) analysis of the human eye in healthy, cataract and pseudophakic states is proposed, under intact and pseudoexfoliative conditions. Several 3D models of the relevant ocular structures were developed, progressively reducing zonular thickness to emulate pseudoexfoliation. The pseudophakic model was subjected to gravity load conditions and different IOL positions to assess their impact on zonular failure. The outcomes indicate minimal gravity impact on the pseudophakic complex, with the horizontal IOL position yielding the least amount of stress in the ocular structures. Pseudoexfoliation heightened zonular stress in the severely affected areas, potentially contributing to disease progression and late in-the-bag IOL dislocation in pseudophakic eyes. The analysis of pre- and post-surgery conditions revealed increased capsular stresses in the pseudophakic eye, potentially offering insights into phenomena such as the recently described dead bag syndrome in specific postoperative cases. This work provides novel insights on the impact of IOL implantation in the human eye, particularly by considering pre-existent degenerative scenarios, and expanding to enhance surgical planning.