Inverse-Designed Anisotropic Intrastromal Corneal Exoskeletons for Keratoconus: A Three-Dimensional Computational Feasibility Study
We propose G-EXO, an inverse-designed intrastromal corneal exoskeleton for keratoconus. Unlike conventional intracorneal ring approaches, G-EXO is conceived as a patient-customizable, sectorial and anisotropic scaffold whose geometry and stiffness are optimized to redistribute corneal deformation and reduce asymmetric optical aberrations. We develop a three-dimensional finite-element screening model with localized ectatic weakening, physiological intraocular pressure, and an intrastromal reinforcement domain. A representative design produced a modest but consistent reduction in pressure-induced coma, with a mesh-refined estimate of about 5%, while displacement and stress metrics were more numerically stable. The study is presented as a computational feasibility framework rather than a clinical validation. Its main contribution is to formulate intrastromal reinforcement as a free-form optical-biomechanical inverse-design problem. Patient-specific tomography, nonlinear anisotropic corneal mechanics, full optical modeling, and ex-vivo validation are identified as the next steps.