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Analysis of the diagnostic accuracy of Belin/Ambrósio Enhanced Ectasia and Corvis ST parameters for subclinical keratoconus. Int Ophthalmol 2022; 43:1465-1475. [PMID: 36255612 DOI: 10.1007/s10792-022-02543-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of the parameters in the Belin/Ambrósio Enhanced Ectasia Display built in Pentacam, which is designed for the screening of subclinical keratoconus (SKC) built in Pentacam, and the parameters in Corneal visualization Scheimpflug technology (Corvis ST). METHODS A retrospective study: The fellow eyes of unilateral keratoconus cases were diagnosed with SKC. Patients presented to Shanxi Eye Hospital with SKC from October 2020 to November 2021 were included as the SKC group, and myopic patients undergoing corneal refractive surgery at the Refractive Surgery Department in our hospital within the same period were included as the control group. The Belin/Ambrósio and Corvis ST parameters were extracted from the system and analyzed using independent samples t test. Receiver operating curves (ROCs) were also created to test the diagnostic accuracy of each parameter. RESULTS There were 70 patients (70 eyes) in the SKC group and 137 patients (137 eyes) in the control group. For Corvis ST parameters, Radius (P = 0.021), PachySlope (P = 0.040), SP-A1 (P = 0.002), A2 Deformation Amp. (P = 0.028), A2 Deflection Length (P < 0.001), Max ICR (P = 0.005), DA Ratio Max (1 mm) (P = 0.023), IR (P = 0.016), CBI (P = 0.003) and TBI (P < 0.001) were statistically different between the two groups. For Belin/Ambrósio parameters, PPI min. Axis, ART min, ART max, ART avg, Pachy min, Front K2, Astig, BAD-Df, BAD-Db, BAD-Dp, BAD-Dt, BAD-Da, BAD-D, PPI min, PPI max, PPI max. Axis, PPI avg and Dist.Apex-Thin.Loc. were significantly different between the two groups (all p < 0.001). TBI and BAD-D showed the best diagnostic accuracy, with AUCs of 0.944 and 0.965, respectively. CONCLUSIONS Some Belin/Ambrósio and Corvis ST parameters differed between SKC eyes and eyes with normal cornea. TBI and BAD-D showed the ideal diagnostic performance for SKC. In clinical practice, conventional corneal topography could not be replaced by Corvis ST.
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Saad A, Binder PS, Gatinel D. Evaluation of the percentage tissue altered as a risk factor for developing post-laser in situ keratomileusis ectasia. J Cataract Refract Surg 2019; 43:946-951. [PMID: 28823442 DOI: 10.1016/j.jcrs.2017.04.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/12/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the currently recommended percentage tissue altered (PTA) metric for its ability to screen for ectasia after laser in situ keratomileusis (LASIK). SETTING Gavin Herbert Eye Institute, University of California, Irvine, California, USA, and Rothschild Foundation, Paris, France. DESIGN Retrospective case series. METHODS The study used a LASIK database created by 1 surgeon for LASIK cases with normal preoperative topography that had a minimum follow-up of 24 months with complete preoperative and intraoperative data to permit the calculation of PTA values to detect eyes at risk for developing ectasia. RESULTS Of the eyes, 593 eyes had complete data and met the inclusion criteria. Based on measured flap thickness, 126 eyes (21%) had a PTA value of 40% or more (mean 44) and a percentage of that flap thickness accounted for the PTA (mean 66.7%; range 34% to 92%). The mean attempted laser ablation was 79.8 μm ± 29.2 (SD), and the mean residual bed thickness was 304.4 ± 29.2 μm (range 212 to 369 μm). No eye developed ectasia over a mean follow-up of 30 months. CONCLUSIONS The current PTA calculation when applied to a LASIK population with normal preoperative topography and flap thickness measured with ultrasound did not predict the risk for ectasia. Differences between study populations and assumptions might have accounted for the different outcomes obtained in the initially published PTA study.
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Affiliation(s)
- Alain Saad
- From the Rothschild Foundation (Saad, Gatinel) and the Center of Expertise and Research in Optics for Clinicians (Saad, Gatinel), Paris, France; American University of Beirut (Saad), Beirut, Lebanon; Gavin Herbert Eye Institute (Binder), Department of Ophthalmology, University of California Irvine, Irvine, California, USA.
| | - Perry S Binder
- From the Rothschild Foundation (Saad, Gatinel) and the Center of Expertise and Research in Optics for Clinicians (Saad, Gatinel), Paris, France; American University of Beirut (Saad), Beirut, Lebanon; Gavin Herbert Eye Institute (Binder), Department of Ophthalmology, University of California Irvine, Irvine, California, USA
| | - Damien Gatinel
- From the Rothschild Foundation (Saad, Gatinel) and the Center of Expertise and Research in Optics for Clinicians (Saad, Gatinel), Paris, France; American University of Beirut (Saad), Beirut, Lebanon; Gavin Herbert Eye Institute (Binder), Department of Ophthalmology, University of California Irvine, Irvine, California, USA
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Ong HS, Farook M, Tan BBC, Williams GP, Santhiago MR, Mehta JS. Corneal Ectasia Risk And Percentage Tissue Altered In Myopic Patients Presenting For Refractive Surgery. Clin Ophthalmol 2019; 13:2003-2015. [PMID: 31686775 PMCID: PMC6798818 DOI: 10.2147/opth.s215144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/13/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose A percentage tissue altered (PTA) score of ≥40% has been advocated as an independent indicator of post-operative ectasia risk following laser in-situ keratomileusis (LASIK). This study was performed to test the hypothesis that refractive procedures, such as laser-assisted sub-epithelial keratectomy (LASEK) or small incision lenticule extraction (SMILE), may alter the range of PTA, within which refractive corneal surgery can be safely performed. Setting Refractive department, tertiary ophthalmic hospital. Design Retrospective observational study. Methods Review of case notes was performed for patients who presented for refractive surgeries, other than LASIK. To determine the risk of corneal ectasia for each patient prior to refractive surgery, we estimated what each patient’s PTA would have been if they had undergone LASIK. The Randleman Ectasia Risk Score System (ERSS) was also calculated. Results 114 eyes (66 patients) were included. 94 eyes underwent SMILE. 20 eyes underwent LASEK. A significant proportion of eyes had PTA ≥40% – SMILE eyes: up to 31.9%, LASEK eyes: up to 60.0% (at presumed LASIK flap of 120 μm). The maximum calculated PTA was up to 47.9% in the SMILE group and up to 51.5% in the LASEK group. Using ERSS, 12.8–16% of SMILE eyes and 15.0–80.0% of LASEK eyes would have been considered to have moderate-to-high ectasia risk. No post-surgical ectasia was observed at 3 years. Conclusion SMILE and LASEK alter the range of PTA, within which corneal refractive surgery may be performed with a lower risk of developing post-operative corneal ectasia; a safe PTA threshold needs to be determined for these procedures before recommendations for clinical practice can be made.
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Affiliation(s)
- Hon Shing Ong
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Mohamed Farook
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore
| | - Benjamin Boon Chuan Tan
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore
| | - Geraint P Williams
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Marcony R Santhiago
- Department of Ophthalmology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
| | - Jodhbir S Mehta
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
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Randleman JB, Akhtar J, Lynn MJ, Ambrósio R, Dupps WJ, Krueger RR, Klyce SD. Comparison of objective and subjective refractive surgery screening parameters between regular and high-resolution Scheimpflug imaging devices. J Cataract Refract Surg 2014; 41:286-94. [PMID: 25537685 DOI: 10.1016/j.jcrs.2014.06.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare objective and subjective metrics from regular and high-resolution Scheimpflug devices (Pentacam) to determine their equivalence and interchangeability for refractive surgery screening. SETTING Emory Vision at Emory University, Atlanta, Georgia, USA. DESIGN Retrospective comparative case series. METHODS Eyes of consecutive screened refractive surgery patients were evaluated with high-resolution and regular Scheimpflug devices. Objective parameters evaluated included keratometry (K) values, central corneal thickness (CCT), and device-generated keratoconus screening indices. Masked expert reviewers subjectively graded images as normal, suspicious, or abnormal. RESULTS One hundred eyes of 50 patients were evaluated. The mean K values were not significantly different (anterior K: high resolution 1.21 diopters [D] ± 1.13 (SD) versus regular 1.15 ± 1.16 D, P = 0.73; posterior K: 0.34 ± 0.23 D versus regular 0.35 ± 0.23 D, P = .67). The mean CCT was significantly thinner in the high-resolution group (514.7 ± 26.6 μm versus 527.6 ± 27.6 μm (P < .0001) with limits of agreement of -12.9 to +17.5 μm. Most keratoconus screening indices were more suspicious with the high-resolution device than with the regular device except the indices of height asymmetry and height deviation. Subjectively, 60% of cases received the same score, high resolution was more suspicious in 28% of cases, and regular was more suspicious in 12% of cases; there was only slight subjective agreement between technologies (κ = 0.26 to 0.31). CONCLUSIONS Regular and high-resolution Scheimpflug imaging devices generated different objective values and significantly different subjective interpretations with poor inter-reviewer agreement. The high-resolution device provided a more conservative overall output. For refractive surgical screening, the 2 devices are not interchangeable. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Affiliation(s)
- J Bradley Randleman
- From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil.
| | - Jihan Akhtar
- From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil
| | - Michael J Lynn
- From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil
| | - Renato Ambrósio
- From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil
| | - William J Dupps
- From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil
| | - Ronald R Krueger
- From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil
| | - Stephen D Klyce
- From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil
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