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El-Naggar MT, Elkitkat RS, Ziada HED, Esporcatte LPG, Ambrósio Jr R. Assessment of Preoperative Risk Factors for Post-LASIK Ectasia Development [Response to Letter]. Clin Ophthalmol 2024; 18:1045-1047. [PMID: 38616949 PMCID: PMC11012686 DOI: 10.2147/opth.s468869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024] Open
Affiliation(s)
- Mohamed Tarek El-Naggar
- Refractive Surgery Unit, Ophthalmology Department, Research Institute of Ophthalmology, Giza, Egypt
| | - Rania Serag Elkitkat
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
- Watany Research and Development Center, Cairo, Egypt
- Ophthalmology Department, Modern University for Technology and Information, Cairo, Egypt
| | - Hossam El-din Ziada
- Cornea and Refractive Surgery Unit, Ophthalmology Department, Faculty of Medicine, AL-Azhar University, Cairo, Egypt
| | - Louise Pellegrino Gomes Esporcatte
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Ambrósio Jr
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro& Maceió, Brazil
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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Alanazi R, Esporcatte LPG, White L, Salomão MQ, Lopes BT, Ambrósio R, Abass A. Investigation of How Corneal Densitometry Artefacts Affect the Imaging of Normal and Keratoconic Corneas. Bioengineering (Basel) 2024; 11:148. [PMID: 38391634 PMCID: PMC10886353 DOI: 10.3390/bioengineering11020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE To investigate corneal densitometry artefacts found in Pentacam Scheimpflug scans and their potential effect on assessing keratoconic (KC) corneas compared to normal (N) corneas. METHODS The current study utilises Pentacam data of 458 N eyes, aged 35.6 ± 15.8 (range 10-87), referred to as the "N group", and 314 KC eyes, aged 31.6 ± 10.8 (range 10-72), referred to as the "KC group", where densitometry data were extracted and analysed via a custom-built MATLAB code. Radial summations of the densitometry were calculated at diameters ranging from 0.5 mm to 5.0 mm. The minimum normalised radial summation of densitometry (NRSD) value and angle were determined at each diameter and then linked. KC cone locations and areas of pathology were determined, and a comparison between N and KC groups was carried out both within the averaged area of pathology and over the corneal surface. RESULTS Joining minimum NRSD trajectory points marked a clear distortion line pointing to the nasal-superior direction at 65° from the nasal meridian. The findings were found to be independent of eye laterality or ocular condition. Consistency was detected in the right and left eyes among both the N and KC groups. The location of the KC cone centre and the area of pathology were determined, and the densitometry output was compared both within the area of pathology and over the whole cornea. When the average densitometry was compared between N and KC eyes within the KC area of pathology, the N group recorded a 16.37 ± 3.15 normalised grey-scale unit (NGSU), and the KC group recorded 17.74 ± 3.4 NGSU (p = 0.0001). However, when the whole cornea was considered, the N group recorded 16.71 ± 5.5 NGSU, and the KC group recorded 15.72 ± 3.98 NGSU (p = 0.0467). A weak correlation was found between the Bad D index and NGSU when the whole measured cornea was considered (R = -0.01); however, a better correlation was recorded within the KC area of pathology (R = 0.21). CONCLUSIONS Nasal-superior artefacts are observed in the densitometry Pentacam maps, and analysis shows no significant differences in their appearance between N or KC corneas. When analysing KC corneas, it was found that the cone positions are mostly on the temporal-inferior side of the cornea, opposite to the densitometry artefact NRSD trajectory. The analysis suggests that the corneal densitometry artefacts do not interfere with the KC area of pathology as it reaches its extreme in the opposite direction; therefore, weighting the densitometry map to increase the contribution of the inferior-temporal cornea and decreasing that of the superior-nasal area would improve the classification or identification of KC if densitometry is to be used as a KC metric.
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Affiliation(s)
- Rami Alanazi
- Department of Materials, Design and Manufacturing Engineering, School of Engineering, University of Liverpool, Liverpool L69 3GH, UK
| | - Louise Pellegrino Gomes Esporcatte
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520-050, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro 20520-050, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04017-030, Brazil
| | - Lynn White
- Research and Development Department, LWVision, Leicester LE18 1DF, UK
| | - Marcella Q Salomão
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520-050, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro 20520-050, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04017-030, Brazil
- Instituto Benjamin Constant, Rio de Janeiro 22290-255, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520-050, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04017-030, Brazil
- Ophthalmology Eye Clinic, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Renato Ambrósio
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro 20520-050, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04017-030, Brazil
- Department of Ophthalmology, Federal University the State of Rio de Janeiro, Rio de Janeiro 22290-240, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis-BrAIN, Rio de Janeiro & Maceió, Rio de Janeiro 20520-050, Brazil
| | - Ahmed Abass
- Department of Materials, Design and Manufacturing Engineering, School of Engineering, University of Liverpool, Liverpool L69 3GH, UK
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Ambrósio R, Salomão MQ, Barros L, da Fonseca Filho JBR, Guedes J, Neto A, Machado AP, Lopes BT, Sena N, Esporcatte LPG. Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift. Eye Vis (Lond) 2023; 10:45. [PMID: 37919821 PMCID: PMC10623885 DOI: 10.1186/s40662-023-00363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea.
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Affiliation(s)
- Renato Ambrósio
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil.
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.
| | - Marcella Q Salomão
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Benjamin Constant Institute, Rio de Janeiro, Brazil
| | - Lorena Barros
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - João Batista R da Fonseca Filho
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Jaime Guedes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Alexandre Neto
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Aydano P Machado
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Computing Institute, Federal University of Alagoas, Maceió, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Department of Ophthalmology, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Nelson Sena
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Louise Pellegrino Gomes Esporcatte
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
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Wu LY, Gomes Esporcatte LP, Li WK, Lin WP, Wu R, White L, Salomão MQ, Lopes BT, Ambrósio R, Abass A. Investigation of the relationship between contact lens design parameters and refractive changes in Ortho-K. Heliyon 2022; 8:e11699. [DOI: 10.1016/j.heliyon.2022.e11699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/28/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022] Open
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Esporcatte LPG, Portes AJF. Ocular manifestations of Chikungunya fever in the chronic phase. Arq Bras Oftalmol 2021; 84:549-553. [PMID: 34320111 DOI: 10.5935/0004-2749.20210081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To identify ocular manifestations in patients with Chikungunya fever in the chronic phase and describe their sociodemographic profile. METHODS Patients with serologic confirmation of Chikungunya infection were included in this transverse study. All subjects underwent a comprehensive ophthalmologic evaluation, including specific lacrimal function tests (tear break-up time test, Schirmer test, and lissamine green). RESULTS Overall, 64 eyes of 32 patients were evaluated. Most patients were women (71.9%), with the mean age of 50.0 ±13.7 years. The mean interval between serologic confirmation and the examination was 12.7 ±7.7 months. Twenty patients (62%) presented with dry eye. No statistically significant association was observed between dry eye and infection diagnosis time (p=0.5546), age (p=0.9120), sex (p=1.00), race (p=0.2269), arthralgia in acute infection (p=0.7930), retro-orbital pain (p=0.3066), and conjunctivitis (p=1.00). CONCLUSION Dry eye was the most prevalent manifestation observed. No signs of intraocular inflammation and affected visual acuity were observed.
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Criado GG, Sena Júnior NB, Mazzeo TJMM, Carvalho MQSHD, Esporcatte LPG, Hilgert GSL, Ambrósio Júnior R. Characterization of subclinical ectasia with integrated corneal tomography and biomechanics assessments. Revista Brasileira de Oftalmologia 2021. [DOI: 10.5935/0034-7280.20210014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Salomão MQ, Hofling-Lima AL, Gomes Esporcatte LP, Lopes B, Vinciguerra R, Vinciguerra P, Bühren J, Sena N, Luz Hilgert GS, Ambrósio R. The Role of Corneal Biomechanics for the Evaluation of Ectasia Patients. Int J Environ Res Public Health 2020; 17:ijerph17062113. [PMID: 32209975 PMCID: PMC7143615 DOI: 10.3390/ijerph17062113] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 12/16/2022]
Abstract
Purpose: To review the role of corneal biomechanics for the clinical evaluation of patients with ectatic corneal diseases. Methods: A total of 1295 eyes were included for analysis in this study. The normal healthy group (group N) included one eye randomly selected from 736 patients with healthy corneas, the keratoconus group (group KC) included one eye randomly selected from 321 patients with keratoconus. The 113 nonoperated ectatic eyes from 125 patients with very asymmetric ectasia (group VAE-E), whose fellow eyes presented relatively normal topography (group VAE-NT), were also included. The parameters from corneal tomography and biomechanics were obtained using the Pentacam HR and Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany). The accuracies of the tested variables for distinguishing all cases (KC, VAE-E, and VAE-NT), for detecting clinical ectasia (KC + VAE-E) and for identifying abnormalities among the VAE-NT, were investigated. A comparison was performed considering the areas under the receiver operating characteristic curve (AUC; DeLong’s method). Results: Considering all cases (KC, VAE-E, and VAE-NT), the AUC of the tomographic-biomechanical parameter (TBI) was 0.992, which was statistically higher than all individual parameters (DeLong’s; p < 0.05): PRFI- Pentacam Random Forest Index (0.982), BAD-D- Belin -Ambrosio D value (0.959), CBI -corneal biomechanical index (0.91), and IS Abs- Inferior-superior value (0.91). The AUC of the TBI for detecting clinical ectasia (KC + VAE-E) was 0.999, and this was again statistically higher than all parameters (DeLong’s; p < 0.05): PRFI (0.996), BAD-D (0.995), CBI (0.949), and IS Abs (0.977). Considering the VAE-NT group, the AUC of the TBI was 0.966, which was also statistically higher than all parameters (DeLong’s; p < 0.05): PRFI (0.934), BAD- D (0.834), CBI (0.774), and IS Abs (0.677). Conclusions: Corneal biomechanical data enhances the evaluation of patients with corneal ectasia and meaningfully adds to the multimodal diagnostic armamentarium. The integration of biomechanical data and corneal tomography with artificial intelligence data augments the sensitivity and specificity for screening and enhancing early diagnosis. Besides, corneal biomechanics may be relevant for determining the prognosis and staging the disease.
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Affiliation(s)
- Marcella Q. Salomão
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro 20520050, Brazil; (M.Q.S.); (L.P.G.E.); (B.L.)
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520050, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis—BrAIN, Rio de Janeiro 20520050, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023062, Brazil;
- Instituto Benjamin Constant, Rio de Janeiro 22290255, Brazil
| | - Ana Luisa Hofling-Lima
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023062, Brazil;
| | - Louise Pellegrino Gomes Esporcatte
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro 20520050, Brazil; (M.Q.S.); (L.P.G.E.); (B.L.)
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520050, Brazil
| | - Bernardo Lopes
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro 20520050, Brazil; (M.Q.S.); (L.P.G.E.); (B.L.)
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520050, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023062, Brazil;
- School of Engineering, University of Liverpool, L69 3GH Liverpool, UK;
| | - Riccardo Vinciguerra
- School of Engineering, University of Liverpool, L69 3GH Liverpool, UK;
- Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Paolo Vinciguerra
- The Eye Center, Humanitas Clinical and Research Center, 20089 Rozzano, Italy;
- Vincieye Clinic, 20141 Milan, Italy
| | - Jens Bühren
- Praxis für Augenheikunde Prof. Bühren, D-60431 Frankfurt, Germany;
| | - Nelson Sena
- Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, Brazil;
| | | | - Renato Ambrósio
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro 20520050, Brazil; (M.Q.S.); (L.P.G.E.); (B.L.)
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520050, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis—BrAIN, Rio de Janeiro 20520050, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023062, Brazil;
- Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, Brazil;
- Correspondence:
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Esporcatte LPG, Salomão MQ, Lopes BT, Vinciguerra P, Vinciguerra R, Roberts C, Elsheikh A, Dawson DG, Ambrósio R. Biomechanical diagnostics of the cornea. Eye Vis (Lond) 2020; 7:9. [PMID: 32042837 PMCID: PMC7001259 DOI: 10.1186/s40662-020-0174-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
Abstract
Corneal biomechanics has been a hot topic for research in contemporary ophthalmology due to its prospective applications in diagnosis, management, and treatment of several clinical conditions, including glaucoma, elective keratorefractive surgery, and different corneal diseases. The clinical biomechanical investigation has become of great importance in the setting of refractive surgery to identify patients at higher risk of developing iatrogenic ectasia after laser vision correction. This review discusses the latest developments in the detection of corneal ectatic diseases. These developments should be considered in conjunction with multimodal corneal and refractive imaging, including Placido-disk based corneal topography, Scheimpflug corneal tomography, anterior segment tomography, spectral-domain optical coherence tomography (SD-OCT), very-high-frequency ultrasound (VHF-US), ocular biometry, and ocular wavefront measurements. The ocular response analyzer (ORA) and the Corvis ST are non-contact tonometry systems that provide a clinical corneal biomechanical assessment. More recently, Brillouin optical microscopy has been demonstrated to provide in vivo biomechanical measurements. The integration of tomographic and biomechanical data into artificial intelligence techniques has demonstrated the ability to increase the accuracy to detect ectatic disease and characterize the inherent susceptibility for biomechanical failure and ectasia progression, which is a severe complication after laser vision correction.
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Affiliation(s)
- Louise Pellegrino Gomes Esporcatte
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rua Conde de Bonfim 211 / 712, Rio de Janeiro, RJ 20520-050 Brazil.,3Department of Ophthalmology, Hospital São Vicente de Paulo, Rio de Janeiro, Brazil
| | - Marcella Q Salomão
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rua Conde de Bonfim 211 / 712, Rio de Janeiro, RJ 20520-050 Brazil.,Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.,5Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Instituto Benjamin Constant, Rio de Janeiro, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,7School of Engineering, University of Liverpool, Liverpool, L69 3GH UK
| | - Paolo Vinciguerra
- 8Department of Biomedical Science, Humanitas University, Rozzano, Italy.,9Eye Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Riccardo Vinciguerra
- 7School of Engineering, University of Liverpool, Liverpool, L69 3GH UK.,Department of Ophthalmology, Humanitas San Pio X Hospital, Milan, Italy
| | - Cynthia Roberts
- 11Department of Ophthalmology and Visual Science, Department of Biomedical Engineering, The Ohio State University, Columbus, OH USA
| | - Ahmed Elsheikh
- 7School of Engineering, University of Liverpool, Liverpool, L69 3GH UK.,12School of Biological Science and Biomedical Engineering, Beihang University, Beijing, China.,13NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Daniel G Dawson
- 14The University of Florida Department of Ophthalmology, Gainesville, FL USA
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rua Conde de Bonfim 211 / 712, Rio de Janeiro, RJ 20520-050 Brazil.,Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.,5Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,15Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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