Automated digital analysis of intraoperative keratoscopy and its correlation with postoperative astigmatism after big-bu
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CORNEA
Automated digital analysis of intraoperative keratoscopy and its correlation with postoperative astigmatism after big-bubble deep anterior lamellar keratoplasty Giuseppe Giannaccare 1 Vincenzo Scorcia 1
&
Andrea Lucisano 1 & Marco Pellegrini 2 & Federico Bernabei 2 & Gianfranco Scuteri 1 &
Received: 19 April 2020 / Revised: 16 July 2020 / Accepted: 25 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate the correlation between postoperative corneal astigmatism (PCA) and values of intraoperative keratoscopy analyzed with a newly developed automated technique in patients undergoing big-bubble (BB) deep anterior lamellar keratoplasty (DALK). Methods Photographs of keratoscope rings taken at the end of BB-DALK were analyzed using ImageJ for the calculation of “roundness” (R): values = 1 indicate a perfect circle. Pearson’s correlation was used to evaluate the relationship between R and PCA that measured 1 week (V1), 3 months (V2), and 18 months (V3), postoperatively. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was used to evaluate the accuracy of R for identifying patients with PCA < 3 diopters (D). The point on the ROC curve nearest to the coordinate (0,100) was used as a cutoff to determine sensitivity and specificity. Results Data from 121 patients were included. The mean value of R*was 0.93 ± 0.04 (range 0.76–0.99). R showed a significant correlation with PA at V3 (R = − 0.42, P < 0.01). The ROC curve had an AUC of 0.69 (95% CI 0.59–0.79). A cutoff value of R = 0.93 had a sensitivity of 70.3% and specificity of 61.0% for identifying patients with PA < 3D at V3. Conclusions This new digital analysis of keratoscope rings allows to identify with reasonably good diagnostic accuracy patients with low values of post-DALK astigmatism correctable with spectacles. Keywords DALK . Deep anterior lamellar keratoplasty . Keratoscopy . Digital analysis . Astigmatism
Introduction Deep anterior lamellar keratoplasty (DALK) consists of the replacement of diseased anterior corneal layers without removing the healthy Descemet’s membrane and endothelium. The main advantages of DALK over penetrating keratoplasty (PK) include the reduced rate of either the immunological Graefe’s Archive for Clinical and Experimental Ophthalmology – Cornea * Giuseppe Giannaccare [email protected] 1
Department of Ophthalmology, University Magna Graecia of Catanzaro, Viale Europa, 88100, Germaneto, Catanzaro, Italy
2
Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
graft rejection and endothelial cell loss or the preservation of eye integrity [1–5]. Despite continuous refinements in the surgical techniques, high astigmatism remains an important drawback of the procedure that may require further surgery in up to 10% of cases [6, 7]. Factors that may contribute to post-DALK astigmatism include, among others, the size and centration of recipient trephination [8], the thickness distribution in the donor but
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