{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:11:20Z","timestamp":1793225480897,"version":"4.5.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swiss Government Excellence Scholarships for Foreign Scholars and Artists"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The cornea plays a role in the refractive power of the eye, and when its natural curvature and thickness are compromised by diseases such as keratoconus or high myopia, this results in loss of visual acuity. Intracorneal rings (ICRs) were developed as a treatment option to restore the natural corneal curvature by implanting rings into tunnels cut within the corneal stroma. However, selecting and placing the appropriate ring can be difficult, and predicting refractive outcomes is challenging.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>The purpose of this study was to better understand the design parameters of the rings that determine postoperative refractive and mechanical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We developed an automated finite element simulation pipeline for ICR implantation and tested 300 variations of 20 ICRs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The outcome of ICR was dominated by the vertical size of the ring; 84% of the change in corneal curvature can be attributed to the vertical size of the ring, while only 13% were attributed to the detailed cross-sectional shape of the ring. However, the cross-sectional shape of the ring is limited to the change in axial length and contact pressure between the ring and the cornea. The horizontal dimension of the ring plays only a minor role in the postoperative outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>These results support Keraring\u2019s approach to ring scaling, in which only the vertical dimension of the ring is changed, while the horizontal dimension remains constant. Numerical models help to understand ICR outcomes, design implants, and personalize empirical nomograms to achieve more successful postoperative outcomes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0311926","type":"journal-article","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T19:22:37Z","timestamp":1733426557000},"page":"e0311926","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of design parameters on the outcome of intrastromal ring surgery using biomechanical simulations"],"prefix":"10.1371","volume":"19","author":[{"given":"Shima","family":"Bahramizadeh-Sajadi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3745-8846","authenticated-orcid":true,"given":"Hamid Reza","family":"Katoozian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Angel","family":"Ariza-Gracia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morteza","family":"Gholami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Baradaran-Rafii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"B\u00fcchler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,12,5]]},"reference":[{"key":"pone.0311926.ref001","doi-asserted-by":"crossref","first-page":"105252","DOI":"10.1016\/j.jmbbm.2022.105252","article-title":"Numerical estimation of stress and refractive power maps in healthy and keratoconus eyes","volume":"131","author":"I Simonini","year":"2022","journal-title":"Journal of the Mechanical Behavior of Biomedical Materials"},{"key":"pone.0311926.ref002","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.ajo.2010.10.034","article-title":"The lifetime economic burden of keratoconus: A decision analysis using a Markov Model","volume":"151","author":"RL Rebenitsch","year":"2011","journal-title":"American Journal of Ophthalmology"},{"key":"pone.0311926.ref003","first-page":"244","volume":"92","author":"DM Gore","year":"2014","journal-title":"Acta Ophthalmologica"},{"key":"pone.0311926.ref004","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1097\/ICO.0000000000000623","article-title":"Global consensus on keratoconus diagnosis","volume":"34","author":"JAP Gomes","year":"2015","journal-title":"Cornea"},{"key":"pone.0311926.ref005","first-page":"101559","article-title":"Keratoconus: An updated review. Contact Lens and Anterior Eye","author":"J Santodomingo-Rubido","year":"2022","journal-title":"Internet]"},{"key":"pone.0311926.ref006","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1177\/1120672121994729","article-title":"Intracorneal circular ring implant with femtosecond laser: Pocket versus tunnel","volume":"32","author":"LJ Izquierdo","year":"2021","journal-title":"European Journal of Ophthalmology"},{"key":"pone.0311926.ref007","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1016\/j.jcrs.2007.06.055","article-title":"Intracorneal ring segment implantation for the management of keratoconus: Safety and efficacy","volume":"33","author":"MA Zare","year":"2007","journal-title":"Journal of Cataract and Refractive Surgery"},{"key":"pone.0311926.ref008","doi-asserted-by":"crossref","first-page":"5583","DOI":"10.1167\/iovs.09-5017","article-title":"Modeling the intracorneal ring segment effect in keratoconus using refractive, Keratometric, and corneal aberrometric data","volume":"51","author":"DP Pi\u00f1ero","year":"2010","journal-title":"Investigative Ophthalmology and Visual Science"},{"key":"pone.0311926.ref009","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1111\/j.1442-9071.2010.02197.x","article-title":"Intracorneal ring segments in ectatic corneal disease\u2014a review","volume":"38","author":"DP Pi\u00f1ero","year":"2010","journal-title":"Clinical and Experimental Ophthalmology"},{"key":"pone.0311926.ref010","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s40123-019-00211-2","article-title":"Intracorneal Ring Segment Implantation in the Management of Keratoconus: An Evidence-Based Approach","volume":"8","author":"D Sakellaris","year":"2019","journal-title":"Ophthalmology and Therapy"},{"key":"pone.0311926.ref011","first-page":"1","article-title":"Corneal Biomechanics After Intrastromal Ring Surgery: Optomechanical In Silico Assessment","volume":"9","author":"M\u00c1 Ariza-gracia","year":"2020","journal-title":"Translational Vision Science and Technology"},{"key":"pone.0311926.ref012","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3928\/1081597X-20201123-03","article-title":"Two-year follow-up of intracorneal ring segments implantation in adolescent patients with keratoconus","volume":"37","author":"C Peris-Mart\u00ednez","year":"2021","journal-title":"Journal of Refractive Surgery"},{"key":"pone.0311926.ref013","first-page":"1","article-title":"Keratoconus: A Review of Medical and Surgical Options.","author":"CM Milliken","year":"2020"},{"key":"pone.0311926.ref014","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.jcrs.2019.02.022","article-title":"Optimization of surgical parameters based on patient-specific models: Application to arcuate keratotomy","volume":"45","author":"O Truffer","year":"2019","journal-title":"Journal of Cataract and Refractive Surgery"},{"key":"pone.0311926.ref015","first-page":"1","article-title":"Effects of intracorneal ring segments implementation technique and design on corneal biomechanics and keratometry in a personalized computational analysis.","volume":"11","author":"NM Bagheri","year":"2021","journal-title":"Scientific Reports [Internet]."},{"key":"pone.0311926.ref016","first-page":"136","article-title":"Predictability, stability and safety of MyoRing implantation in Keratoconic eyes during one year follow-up","volume":"26","author":"SM Nobari","year":"2014","journal-title":"Iranian Journal of Ophthalmology"},{"key":"pone.0311926.ref017","doi-asserted-by":"crossref","first-page":"303","DOI":"10.3928\/1081597X-20130415-01","article-title":"Sources of medical error in refractive surgery","volume":"29","author":"M Moshirfar","year":"2013","journal-title":"Journal of Refractive Surgery"},{"key":"pone.0311926.ref018","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1001\/jamaophthalmol.2015.4776","article-title":"Global Survey of Corneal Transplantation and Eye Banking.","volume":"134","author":"P Gain","year":"2016","journal-title":"JAMA Ophthalmol"},{"key":"pone.0311926.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40662-020-00184-5","article-title":"Artificial neural network to guide intracorneal ring segments implantation for keratoconus treatment: a pilot study.","volume":"7","author":"C Fariselli","year":"2020","journal-title":"Eye and Vision"},{"key":"pone.0311926.ref020","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.cmpb.2014.04.003","article-title":"A new approach based on Machine Learning for predicting corneal curvature (K1) and astigmatism in patients with keratoconus after intracorneal ring implantation.","volume":"116","author":"MA Vald\u00e9s-Mas","year":"2014","journal-title":"Computer Methods and Programs in Biomedicine"},{"key":"pone.0311926.ref021","doi-asserted-by":"crossref","unstructured":"Valdes-Mas MA, Martin JD, Ruperez MJ, Peris C, Monserrat C. Machine learning for predicting astigmatism in patients with keratoconus after intracorneal ring implantation. 2014 IEEE-EMBS International Conference on Biomedical and Health Informatics, BHI 2014. 2014;756\u20139.","DOI":"10.1109\/BHI.2014.6864474"},{"key":"pone.0311926.ref022","doi-asserted-by":"crossref","first-page":"490","DOI":"10.3928\/1081597X-20130617-08","article-title":"Effect of hydration state and storage media on corneal biomechanical response from in vitro inflation tests","volume":"29","author":"S Kling","year":"2013","journal-title":"Journal of Refractive Surgery"},{"key":"pone.0311926.ref023","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s10237-018-1013-z","article-title":"Template-based methodology for the simulation of intracorneal segment ring implantation in human corneas.","volume":"17","author":"J Flecha-Lesc\u00fan","year":"2018","journal-title":"Biomechanics and Modeling in Mechanobiology [Internet]."},{"key":"pone.0311926.ref024","first-page":"1","article-title":"To study the effects of intrastromal corneal ring geometry and surgical conditions on the postsurgical outcomes through finite element analysis.","volume":"16","author":"SN Khan","year":"2016","journal-title":"Journal of Mechanics in Medicine and Biology."},{"key":"pone.0311926.ref025","first-page":"1","article-title":"Refractive changes of a new asymmetric intracorneal ring segment with variable thickness and base width: A 2D finite-element model.","volume":"16","author":"GG de Oteyza","year":"2021","journal-title":"PLoS ONE."},{"key":"pone.0311926.ref026","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1167\/iovs.12-10852","article-title":"Finite-element modeling of intrastromal ring segment implantation into a hyperelastic cornea","volume":"54","author":"S Kling","year":"2013","journal-title":"Investigative Ophthalmology and Visual Science"},{"key":"pone.0311926.ref027","first-page":"3314","article-title":"A comparative study on common scenarios of single-segment and double-segment intracorneal ring segments in a keratoconus corneal model","volume":"15","author":"S Bahramizadeh-sajadi","year":"2022","journal-title":"Iranian Journal of Biomedical Engineering"},{"key":"pone.0311926.ref028","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.medengphy.2012.09.006","article-title":"Stress free configuration of the human eye","volume":"35","author":"A Elsheikh","year":"2013","journal-title":"Medical Engineering and Physics"},{"key":"pone.0311926.ref029","doi-asserted-by":"crossref","first-page":"60","DOI":"10.5935\/0004-2749.20140016","article-title":"Finite element modelling of cornea mechanics: A review","volume":"77","author":"TM Nejad","year":"2014","journal-title":"Arquivos Brasileiros de Oftalmologia"},{"key":"pone.0311926.ref030","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1002\/jbmr.2437","article-title":"Bone volume fraction and fabric anisotropy are better determinants of trabecular bone stiffness than other morphological variables","volume":"30","author":"G Maquer","year":"2015","journal-title":"Journal of Bone and Mineral Research"},{"key":"pone.0311926.ref031","first-page":"1","article-title":"VisuMax Application Training ICR, Application support refractive lasers.","author":"V. Application","year":"2016","journal-title":"Carl Zeiss Meditec AG, Application Support Refractive Lasers"},{"key":"pone.0311926.ref032","volume-title":"Computational planning tools in opthomology: Intrastromal corneal ring surgery.","author":"J. Flecha-lesc\u00fan","year":"2020"},{"key":"pone.0311926.ref033","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1167\/tvst.11.3.19","article-title":"Optical evaluation of intracorneal ring segment surgery in keratoconus","volume":"11","author":"N Alejandre","year":"2022","journal-title":"Translational Vision Science and Technology"},{"key":"pone.0311926.ref034","first-page":"89","article-title":"Full-ring Intrastromal Corneal Implantation for Correcting High Myopia in Patients with Severe Keratoconus.","volume":"5","author":"K Jadidi","year":"2016","journal-title":"Medical hypothesis, discovery & innovation ophthalmology journal [Internet]."},{"key":"pone.0311926.ref035","doi-asserted-by":"crossref","first-page":"2929","DOI":"10.1007\/s10792-019-01121-9","article-title":"Efficacy of complete rings (MyoRing) in treatment of Keratoconus: a systematic review and meta-analysis.","volume":"39","author":"L Janani","year":"2019","journal-title":"International Ophthalmology"},{"key":"pone.0311926.ref036","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.optom.2016.06.003","article-title":"Myoring treatment of myopia","volume":"10","author":"A. Daxer","year":"2017","journal-title":"Journal of Optometry"},{"key":"pone.0311926.ref037","first-page":"123","article-title":"Long-term results of MyoRing treatment of keratoconus","volume":"10","author":"A Daxer","year":"2017"},{"key":"pone.0311926.ref038","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s00417-015-3231-8","article-title":"Visual outcomes after femtosecond-assisted intracorneal MyoRing implantation: 18 months of follow-up","volume":"254","author":"M Mohebbi","year":"2016","journal-title":"Graefe\u2019s Archive for Clinical and Experimental Ophthalmology"},{"key":"pone.0311926.ref039","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/ICO.0b013e3182215a15","article-title":"KeraRing intrastromal corneal ring segments for correction of keratoconus","volume":"31","author":"AM Gharaibeh","year":"2012","journal-title":"Cornea"},{"key":"pone.0311926.ref040","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S0886-3350(13)80404-X","article-title":"Flattening of central corneal curvature with Intrastromal Corneal Rings of increasing thickness: An eye-bank eye study","volume":"19","author":"TE Burris","year":"1993","journal-title":"Journal of Cataract and Refractive Surgery"},{"key":"pone.0311926.ref041","first-page":"345","article-title":"A Simple Numerical Approach to Mimic MyoRing Surgery in Keratoconus Corneas based on Optical Coherence Tomography","volume":"5","author":"A Ebrahimian","year":"2019","journal-title":"Cronicon EC OPHTHALMOLOGY"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0311926","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T19:22:56Z","timestamp":1733426576000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0311926"}},"subtitle":[],"editor":[{"given":"Petros Cyrus","family":"Kayange","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,12,5]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0311926","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,5]]}}}