title: Finite Element Analysis of Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) Surgery Allograft to Predict Endothelial Cell Loss.
abstract: To develop high fidelity finite element (FE) models of the Descemet's stripping automated endothelial keratoplasty (DSAEK) allograft to estimate the stress distributions generated on the allograft during its deformed state in popular allograft insertion configurations and qualitatively correlate the stress distributions to postsurgical endothelial cell (EC) loss.
  
  
  
  Corneal allograft simulation was performed using ANSYS (Canonsburg, PA, USA) utilizing isotropic nonlinear hyperelastic corneal material properties to evaluate the stress distributions generated on the DSAEK allograft during popular allograft insertion configurations, namely forceps, taco, and double-coil insertion configurations. The gathered FE simulation results were qualitatively compared with published clinical studies to verify the simulation results.
  
  
  
  The FE simulation results demonstrate that high stress regions predicted by FE model results correctly predict the areas of postsurgical EC loss as published in the studies available in open literature. The FE simulation stress magnitude results suggest that highest EC loss due to mechanical bending trauma occurs in double-coil configuration followed by forceps and then taco configuration.
  
  
  
  The results of the presented FE simulation study highlight that allograft regions with high stress distribution demonstrate postsurgical EC loss in clinical studies. The modeling procedures presented in this research can be utilized to develop novel surgical devices/techniques that can modulate the postsurgical EC loss due to mechanical bending trauma and facilitate allograft unfolding inside the AC, thereby improving the results of the DSAEK surgical procedure.
authors.affiliation: a Micro Manufacturing Medical Automation and Robotics Laboratory, Department of Mechanical and Aerospace Engineering , The University of Texas at Arlington , Arlington , Texas , USA.
authors.forename: Salman N
authors.initials: SN
authors.lastname: Khan
authors.affiliation: a Micro Manufacturing Medical Automation and Robotics Laboratory, Department of Mechanical and Aerospace Engineering , The University of Texas at Arlington , Arlington , Texas , USA.
authors.forename: Panos S
authors.initials: PS
authors.lastname: Shiakolas
mesh_terms: D064591:Allografts; D002452:Cell Count; D003198:Computer Simulation; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis* / Q000209:etiology; D057111:Descemet Stripping Endothelial Keratoplasty / Q000295:instrumentation / Q000379:methods*; D042783:Endothelial Cells / Q000473:pathology*; D020342:Finite Element Analysis; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications; D013314:Stress, Mechanical; D014019:Tissue Donors
keywords: Corneal endothelial cell loss; DSAEK allograft inserter; DSAEK injector; DSEK; Descemet’s stripping endothelial keratoplasty