In Journal of cataract and refractive surgery
PURPOSE : To develop a novel virtual surgery simulation platform to predict postoperative corneal stiffness (Kcmean) after laser vision correction (LVC) surgery.
SETTING : Narayana Nethralaya eye hospital and Sankara Nethralaya, India; Humanitas Clinical and Research Center, Italy.
DESIGN : Retrospective, observational case series.
METHODS : 529 eyes from 529 patients from three eye centres and 10 post-SMILE ectasia eyes were included. The software (called AcuSimX™) derived the anisotropic, fibril and extra-cellular matrix biomechanical properties (using finite element calculation) of the cornea using the preoperative Corvis-ST, Pentacam (OCULUS Optikgerate Gmbh, Germany) measurement and inverse finite element method assuming published healthy collagen fibril orientations. Then, the software computed postoperative Kcmean was adjusted with an artificial intelligence (AI) model (Orange AI, Slovenia) for measurement uncertainties. A decision tree was developed to classify ectasia from normal eyes using the software computed and preoperative parameters.
RESULTS : In the training cohort (n = 371), the mean absolute error (MAE) and intraclass correlation coefficient (ICC) were 6.24 N/m and 0.84 [95% CI: 0.80-0.87], respectively. Similarly in the test cohort (n = 158), these were 6.47 N/m and 0.84 [0.78-0.89], respectively. In the 10 ectasia eyes, the measured in vivo (74.01 [70.01, 78.01]) and software computed (74.1 [69.03, 79.17]) Kcmean weren't statistically different (p=0.96). While no statistically significant differences in these values were observed between the stable and ectasia groups (p≥0.14), the decision tree classification had an AUROC of 1.0.
CONCLUSION : The novel software provided an easy to use virtual surgery simulation platform for post-LVC corneal stiffness prediction by clinicians and was assessed in post-SMILE ectasia eyes. Further assessments with ectasia after surgeries are required.
Francis Mathew, Shetty Rohit, Padmanabhan Prema, Vinciguerra Riccardo, Vinciguerra Paolo, Lippera Myrta, Matalia Himanshu, Khamar Pooja, Chinnappaiah Nandini, Mukundan Deepa, Nuijts Rudy M M A, Roy Abhijit Sinha
2023-Feb-15
