Numerical stress analysis of the iris tissue induced by pupil expansion: Comparison of commercial devices

PLoS One. 2018 Mar 14;13(3):e0194141. doi: 10.1371/journal.pone.0194141. eCollection 2018.

Abstract

Purpose: (1) To use finite element (FE) modelling to estimate local iris stresses (i.e. internal forces) as a result of mechanical pupil expansion; and to (2) compare such stresses as generated from several commercially available expanders (Iris hooks, APX dilator and Malyugin ring) to determine which design and deployment method are most likely to cause iris damage.

Methods: We used a biofidelic 3-part iris FE model that consisted of the stroma, sphincter and dilator muscles. Our FE model simulated expansion of the pupil from 3 mm to a maximum of 6 mm using the aforementioned pupil expanders, with uniform circular expansion used for baseline comparison. FE-derived stresses, resultant forces and area of final pupil opening were compared across devices for analysis.

Results: Our FE models demonstrated that the APX dilator generated the highest stresses on the sphincter muscles, (max: 6.446 MPa; average: 5.112 MPa), followed by the iris hooks (max: 5.680 MPa; average: 5.219 MPa), and the Malyugin ring (max: 2.144 MPa; average: 1.575 MPa). Uniform expansion generated the lowest stresses (max: 0.435MPa; average: 0.377 MPa). For pupil expansion, the APX dilator required the highest force (41.22 mN), followed by iris hooks (40.82 mN) and the Malyugin ring (18.56 mN).

Conclusion: Our study predicted that current pupil expanders exert significantly higher amount of stresses and forces than required during pupil expansion. Our work may serve as a guide for the development and design of next-generation pupil expanders.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Finite Element Analysis*
  • Humans
  • Models, Biological*
  • Mydriasis / physiopathology*
  • Pupil*
  • Stress, Mechanical*

Grant support

We acknowledge funding from the Singapore National Eye Centre (SNEC) - Research Health Endowment Fund (HREF) Device Research and Development fund (R1412/98/2016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.