Clinical and laboratory investigation of the biomechanical properties of the cornea

Understanding the biomechanical properties of the cornea is important in order to develop and improve new reliable standard procedures which can be used effectively to assess corneal behaviour in any disease condition, or before/after any ocular surgery. We believe that the Ocular Response Analyzer (ORA) is the only device that can measures the biomechanical properties of the cornea in vivo. However, it has been used for the first time both in vivo and in vitro. This thesis presents a clinical and laboratory investigation of the biomechanical properties of the cornea before/after LASIK and corneal cross-linking to improve our understanding of the knowledge required in both the laboratory and the clinic. Different machines were used in this project, including an ORA, an Oculus Pentacam, a spectrophotometer and a UV-X Illumination system. Laser in situ keratomileusis (LASIK) is, at present, one of the most well-known operations used to correct refractive errors; however, ocular problems arising from corneal thinning have been reported in some previous studies. Therefore, I looked at the effects of surgery on the central/peripheral thickness and the anterior/posterior curvature, and determined to what extent they affect the biomechanical properties of the cornea. During the past decade, much research has focused on improving and developing a new operation called corneal collagen cross-linking with riboflavin and UVA, which is used to stop the progression of keratectasia in the cornea (which occurs in keratoconus and sometimes follows refractive surgery). In the next phase, a range of experiments were conducted on cross-linking to determine to what extent this operation affects the molecular structure and biomechanical properties of the cornea. This thesis has shown for the first time that it is possible to obtain ORA signals in vitro and this opened up the possibility of examining whole eyes as well as excised corneas. It is also confirmed that the values of CH do not represent only a corneal biomechanical property, but rather depend on the presence of the rest of the eye. These in vitro studies have opened up a number of possibilities the future corneal biomechanical studies.