There has been widespread interest in corneal biomechanics over recent years, driven largely by the advancements in, and the popularity of refractive surgery techniques and subsequent concerns over their safety. Lately there has been interest into whether crosslinking, which is currently used for the treatment of keratoconus, could be developed as a minimally invasive technique to change the refractive power of the cornea by selectively changing the corneal biomechanics in specific regions to induce a shape change. Successful application of this technique requires a detailed understanding of corneal biomechanics and so far, little is known about the biomechanics of this complex tissue. The current lack of understanding can be mostly attributed to the absence of a suitable measurement technique capable of examining the dynamic behaviour of the cornea under physiological loading conditions. This thesis describes the development of a novel full-field, ex vivo, measurement method incorporating speckle interferometric techniques, to examine the biomechanics of the cornea before and after crosslinking in response to hydrostatic pressure fluctuations representative of those that occur in vivo during the cardiac cycle. The eventual measurement system used for the experiments detailed in this thesis incorporated; an Electronic Speckle Pattern Interferometer (ESPI), a Lateral Shearing Interferometer (LSI) and a fringe projection shape measurement system. The combination of these systems enabled the 3-dimensional components of surface displacement and the 1st derivative of surface displacement to be determined in response to small pressure fluctuations up to 1 mmHg in magnitude. The use of both ESPI and LSI together also enabled the applicability of LSI for measurement of non-flat surfaces to be assessed, and limitations and error sources to be identified throughout this work. To enable the measurement of corneal biomechanics, part of this thesis was concerned with the design of a bespoke loading rig. A chamber was designed that could accommodate tissue of both porcine and human origin. This chamber was linked to a hydraulic loading rig, whereby the cornea could be held at a baseline pressure representative of normal intraocular pressure and small pressure variations could be introduced by the automated vertical movement of the reservoir supplying the chamber. Experiments were conducted on a range of non-biological samples with both flat and curved surface topography, and both uniform and non-uniform mechanical properties, to determine if the measurement configuration was giving the expected measurement data and the loading rig was stable and repeatable. Following experiments on non-biological samples, a range of experiments were conducted on porcine corneas to develop a suitable testing methodology and address some of the challenges associated with corneal measurement, including transparency and hydration instability. During these investigations, a suitable surface coating was identified to generate an adequate return signal from the corneal surface, while not interfering with the response. Alongside this, the natural variation in the response of the cornea was investigated over the total experimental time, and a range of data was presented on corneas before and after crosslinking, which confirmed the suitability of the measurement methods for the assessment of crosslinking. Ultimately, a small sample size of six human corneas were investigated before and after crosslinking in specific topographic locations. From the experiments on human and porcine corneas, full-field maps of surface deformation have been presented, and a compliant region incorporating the peripheral and limbal areas has been identified as being fundamental to the response of the cornea to small pressure fluctuations. In addition to this, the regional effects of crosslinking in four different topographic locations on corneal biomechanics have been evaluated. From this, it has been demonstrated that crosslinking in specific regions in isolation can influence the way the cornea deforms to physiological-scale fluctuations in hydrostatic pressure and this could have implications for refractive correction.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:734154 |
| Date | January 2017 |
| Creators | Wilson, Abby |
| Publisher | Loughborough University |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://dspace.lboro.ac.uk/2134/28380 |
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