B. Calvo

Biomechanical modeling of refractive corneal surgery.

The aim of refractive corneal surgery is to modify the curvature of the cornea to improve its dioptric properties. With that goal, the surgeon has to define the appropriate values of the surgical parameters in order to get the best clinical results, i.e., laser and geometric parameters such as depth and location of the incision, for each specific patient. A biomechanical study before surgery is therefore very convenient to assess quantitatively the effect of each parameter on the optical outcome. A mechanical model of the human cornea is here proposed and implemented under a finite element context to simulate the effects of some usual surgical procedures, such as photorefractive keratectomy (PRK), and limbal relaxing incisions (LRI). This model considers a nonlinear anisotropic hyperelastic behavior of the cornea that strongly depends on the physiological collagen fibril distribution. We evaluate the effect of the incision variables on the change of curvature of the cornea to correct myopia and astigmatism. The obtained results provided reasonable and useful information in the procedures analyzed. We can conclude from those results that this model reasonably approximates the corneal response to increasing pressure. We also show that tonometry measures of the IOP underpredicts its actual value after PRK or LASIK surgery.

Mechanical behaviour of synthetic surgical meshes: Finite element simulation of the herniated abdominal wall

The material properties of meshes used in hernia surgery contribute to the overall mechanical behaviour of the repaired abdominal wall. The mechanical response of a surgical mesh has to be defined since the haphazard orientation of an anisotropic mesh can lead to inconsistent surgical outcomes. This study was designed to characterize the mechanical behaviour of three surgical meshes (Surgipro®, Optilene® and Infinit®) and to describe a mechanical constitutive law that accurately reproduces the experimental results. Finally, through finite element simulation, the behaviour of the abdominal wall was modelled before and after surgical mesh implant. Uniaxial loading of mesh samples in two perpendicular directions revealed the isotropic response of Surgipro® and the anisotropic behaviour of Optilene® and Infinit®. A phenomenological constitutive law was used to reproduce the measured experimental curves. To analyze the mechanical effect of the meshes once implanted in the abdomen, finite element simulation of the healthy and partially herniated repaired rabbit abdominal wall served to reproduce wall behaviour before and after mesh implant. In all cases, maximal displacements were lower and maximal principal stresses higher in the implanted abdomen than the intact wall model. Despite the fact that no mesh showed a behaviour that perfectly matched that of abdominal muscle, the Infinit® mesh was able to best comply with the biomechanics of the abdominal wall.

Finite element simulation of arcuates for astigmatism correction

In order to simulate the corneal incisions used to correct astigmatism, a three-dimensional finite element model was generated from a simplified geometry of the anterior half of the ocular globe. A hyperelastic constitutive behavior was assumed for cornea, limbus and sclera, which are collagenous materials with a fiber structure. Due to the preferred orientations of the collagen fibrils, corneal and limbal tissues were considered anisotropic, whereas the sclera was simplified to an isotropic one assuming that fibrils are randomly disposed. The reference configuration, which includes the initial strain distribution that balances the intraocular pressure, is obtained by an iterative process. Then the incisions are simulated. The final positions of the nodes belonging to the incised meridian and to the perpendicular one are fitted by both radii of curvature, which are used to calculate the optical power. The simulated incisions were those specified by Lindstroms nomogram [Chu, Y., Hardten, D., Lindquist, T., Lindstrom, R., 2005. Astigmatic keratotomy. Duanes Ophthalmology. Lippincott Williams and Wilkins, Philadelphia] to achieve 1.5, 2.25, 3.0, 4.5 and 6.0D of astigmatic change, using the next values for the parameters: length of 45 degrees , 60 degrees and 90 degrees , an optical zone of 6mm, single or paired incisions. The model gives results similar to those in Lindstroms nomogram [Chu et al., 2005] and can be considered a useful tool to plan and simulate refractive surgery by predicting the outcomes of different sorts of incisions and to optimize the values for the parameters involved: depth, length, position.

Passive nonlinear elastic behaviour of skeletal muscle: Experimental results and model formulation

The goal of this study was to characterize the passive elastic behaviour of muscle and tendon tissues of rat tibialis anterior. For that purpose, tissue samples from 3 month old female Wistar rats (210+/-11g) were mechanically tested in vitro. Moreover, an in vivo device was developed to measure the muscle-tendon unit response to increasing load. Mechanical tests, consisting of uniaxial loading along the longitudinal axis of tendon and muscle strips, revealed the nonlinear mechanical behaviour of these tissues. A material model was formulated and its parameters fit to the experimental data using the Levenberg-Marquardt optimization algorithm. The fit goodness was assessed and R(2) values close to 1 and very low epsilon values were obtained. The passive behaviour of a future finite element model of a muscle-tendon unit will be validated against the in vivo passive extension tests by comparing the reaction force-extension curves.

On modelling damage process in vaginal tissue.

The goal of this study was to characterize and model the damage process in prolapsed vaginal tissue undergoing finite deformations. Experiments in prolapsed vaginal tissue revealed that a softening process occurs before tissues rupture. This nonlinear damage behavior requires a continuum damage theory commonly used to describe the softening behavior of soft tissues under large deformations. The structural model here presented was built within the framework of nonlinear continuum mechanics. Tissue damage was simulated considering different damage behaviors for the matrix and the fibers. The model parameters were fit to the experimental data obtained from prolapsed vaginal tissue undergoing finite deformations in uniaxial tension tests. The tests were developed with samples cut along the longitudinal axis of the vagina. The damage model was able to predict the stress-strain behavior and the damage process accurately. The error estimations pointed to an excellent agreement between experimental results and model fittings. For all the fitted data, the normalized RMS error epsilon presented very low values and the coefficient of determination R2 was close to 1.

Evaluation of in vitro efficacy of combined riboflavin and ultraviolet a for Acanthamoeba isolates.

PURPOSE To evaluate in vitro the amoebicidal effects of riboflavin and ultraviolet A (UVA) collagen cross-linking. DESIGN Experimental study, laboratory investigation. METHODS Two different strains of Acanthamoeba species were tested identically. Four treatment groups were considered: group 1 consisted of 0.1% riboflavin and 30-minute UVA irradiation; group 2 consisted of 0.1% riboflavin and 60-minute UVA irradiation; group 3 consisted of no riboflavin and no UVA exposure; group 4 consisted of 0.1% riboflavin and no UVA exposure. The application of UVA was performed under the parameters used for in vivo corneal collagen cross-linking. RESULTS In all cases, cysts and trophozoites were detected 24 hours after treatment at a radial distance from the center of the seeding point more than 5 mm, indicating that the amoebae were viable. All treated and untreated groups of amoebae from the 2 strains exhibited growth (radii of 14 to 15 mm in groups 1, 3, and 4; radius of 12 mm in group 2). The final morphologic features of the 2 strains of trophozoites that received treatment were similar to those of the initial seeding group and the untreated control group. CONCLUSIONS The results obtained in our study show that a single dose (30 or 60 minutes) of cross-linking cannot achieve eradication in the 2 different Acanthamoeba strains examined. However, in vitro results do not always indicate in vivo efficacy, so future studies should test the validity of this treatment for Acanthamoeba keratitis.

Good Vibrations: A Modal Analysis Approach for Sequential Non-rigid Structure from Motion

We propose an online solution to non-rigid structure from motion that performs camera pose and 3D shape estimation of highly deformable surfaces on a frame-by-frame basis. Our method models non-rigid deformations as a linear combination of some mode shapes obtained using modal analysis from continuum mechanics. The shape is first discretized into linear elastic triangles, modelled by means of finite elements, which are used to pose the force balance equations for an undamped free vibrations model. The shape basis computation comes down to solving an eigenvalue problem, without the requirement of a learning step. The camera pose and time varying weights that define the shape at each frame are then estimated on the fly, in an online fashion, using bundle adjustment over a sliding window of image frames. The result is a low computational cost method that can run sequentially in real-time. We show experimental results on synthetic sequences with ground truth 3D data and real videos for different scenarios ranging from sparse to dense scenes. Our system exhibits a good trade-off between accuracy and computational budget, it can handle missing data and performs favourably compared to competing methods.

Experimental study and constitutive modeling of the viscoelastic mechanical properties of the human prolapsed vaginal tissue

In this paper, the viscoelastic mechanical properties of vaginal tissue are investigated. Using previous results of the authors on the mechanical properties of biological soft tissues and newly experimental data from uniaxial tension tests, a new model for the viscoelastic mechanical properties of the human vaginal tissue is proposed. The structural model seems to be sufficiently accurate to guarantee its application to prediction of reliable stress distributions, and is suitable for finite element computations. The obtained results may be helpful in the design of surgical procedures with autologous tissue or prostheses.

Mechanical characterization of the softening behavior of human vaginal tissue

The mechanical properties of vaginal tissue need to be characterized to perform accurate simulations of prolapse and other pelvic disorders that commonly affect women. This is also a fundamental step towards the improvement of therapeutic techniques such as surgery. In this paper, the softening behavior or Mullins effect of vaginal tissue is studied by proposing an appropriate constitutive model. This effect is an important factor after the birth, since vaginal tissue has been supporting a high load distribution and therefore does not recover its original behavior. Due to the anisotropy of the tissue, the mechanical testing of vaginal tissue, consists in loading-unloading uniaxial tension tests performed along the longitudinal and transverse axes of the vagina. A directional pseudo-elastic model was used to reproduce the inelastic behavior of the tissue. The obtained results may be helpful in the design of surgical procedures with autologous tissue or smart prostheses. A good qualitative agreement has been found between the numerical and experimental results for the vaginal tissue examples, indicating that the constitutive softening model can capture the typical stress-strain behavior observed in this kind of fibrous soft tissue.

Mechanical characterization and constitutive modelling of the damage process in rectus sheath

The aim of this study is to characterize and model the damage process in the anterior rectus abdominal aponeurosis (anterior rectus sheath) undergoing finite deformations. The resistance of the anterolateral abdominal aponeuroses is important when planning the surgical repair of incisional hernias, among other medical procedures. Previous experiments in prolapsed vaginal tissue revealed that a softening process occurs before tissue rupture. This nonlinear damage behaviour requires a continuum damage theory commonly used to describe the softening behaviour of soft tissues under large deformations. The structural model presented here was built within the framework of non-linear continuum mechanics. Tissue damage was simulated considering different damage behaviours for the matrix and the collagen fibres. The model parameters were fit to the experimental data obtained from anterior rectus sheath samples undergoing finite deformations in uniaxial tension tests. The tests were carried out with samples cut along the direction of the collagen fibres, and transversal to the fibres. Longitudinal and transverse mechanical properties of human anterior rectus sheath are significantly different. The damage model was able to predict the stress-strain behaviour and the damage process accurately. The error estimations pointed to an excellent agreement between experimental results and model fittings. For all the fitted data, the normalized RMS error ε presented very low values and the coefficient of determination R(2) was close to 1. The present work constitutes the first attempt (as far as the authors know) to present a damage model for the human rectus sheath.