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تسجيل مستخدم جديدEvaluation of central corneal thickness in keratoconus and normal corneas during air puff indentation
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Purpose: This study aimed to investigate the actual changes of central corneal thickness (CCT) in keratoconus and normal corneas during air puff indentation, by using corneal visualization Scheimpflug technology (Corvis ST). Methods: A total of 32 keratoconic eyes and 46 normal eyes were included in this study. Three parameters of CCTinitial, CCTfinal and CCTpeak were selected to represent the CCT at initial time, final time and highest corneal concavity, respectively, during air puff indentation. Wilcoxon signed rank test (paired sample test) was used to assess the differences between these 3 parameters in both keratoconus and normal groups. Univariate linear regression analysis was performed to determine the effect of CCTinitial on CCTpeak and CCTfinal, as well as the impact of air puff force on CCT in each group. Receiver operating characteristic (ROC) curves were constructed to evaluate the discriminative ability of the 3 parameters. Results: The results demonstrated that CCTpeak and CCTfinal were significantly decreased (p<0.01) compared to CCTinitial in both keratoconus and normal groups. Regression analysis indicated a significant positive correlation between CCTpeak and CCTinitial in normal cornea group (R2=0.337, p<0.01), but not in keratoconus group (R2=0.029, p=0.187). Likewise, regression models of air puff force and CCT revealed the different patterns of CCT changes between keratoconus and normal cornea groups. Furthermore, ROC curves showed that CCTpeak exhibited the greatest AUC (area under ROC curve) of 0.940, with accuracy, sensitivity and specificity of 94.9%, 87.5% and 100%, respectively. Conclusions: CCT may change during air puff indentation, and is significantly different between keratoconus and normal cornea groups. The changing pattern is useful for the diagnosis of keratoconus, and lays the foundation for corneal biomechanics.
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PURPOSE: Among the current practices for keratoconus recognition using biomechanical parameters from Corvis ST, matching intra-ocular pressure (IOP) is often required to eliminate the biasing influence; as a result, the combined biomechanical paramet
ers determined from IOP-unmatched scenario possibly bring in confounding influence. This paper was therefore designed to introduce a novel compatible parameter set (CPS) determined from IOP-matched scenario, hopefully could show its compatibility and superiority for recognizing keratoconus in both IOP-matched and not scenarios. METHODS: A total of 335 eyes were included. Among them, 70 eyes were used to determined CPS by forward logistics regression, 62 eyes were used to validate CPS in IOP-matched scenario, and resting 203 eyes were used to validate CPS in IOP-unmatched scenario. To analyze its superiority, CPS was also compared with other two reported Biomechanical Indexes (aCBI and DCR) in both scenarios. Receiver operating characteristic curves (ROC), accuracy, FI, sensitivity and specificity were used to access and compare the performance of these three parameter sets in both scenarios. RESULTS: The resulting CPS was comprised of only 3 biomechanical parameters: DA Ratio Max 1mm (DRM1), the first applanation time (AT1) and an energy loading parameter (Eload). In the IOP-matched validation, the area under ROC (AUC) reached 95.73%, with an accuracy of 95.2%, sensitivity of 93.5% and specificity of 96.8% (leave one out cross-validation). All these indicators reached 96.54%, 95.1%, 95.6% and 94.6% respectively, in the IOP-unmatched validation (leave one out cross-validation). Surprisingly, CPS performed better than other two parameter sets on a whole. CONCLUSIONS: The parameter set determined from IOP-matched scenario indeed exhibit its superiority for differentiation of keratoconus and normal corneas, regardless of IOP-matched or not.
Corneal thickness (pachymetry) maps can be used to monitor restoration of corneal endothelial function, for example after Descemets membrane endothelial keratoplasty (DMEK). Automated delineation of the corneal interfaces in anterior segment optical
coherence tomography (AS-OCT) can be challenging for corneas that are irregularly shaped due to pathology, or as a consequence of surgery, leading to incorrect thickness measurements. In this research, deep learning is used to automatically delineate the corneal interfaces and measure corneal thickness with high accuracy in post-DMEK AS-OCT B-scans. Three different deep learning strategies were developed based on 960 B-scans from 50 patients. On an independent test set of 320 B-scans, corneal thickness could be measured with an error of 13.98 to 15.50 micrometer for the central 9 mm range, which is less than 3% of the average corneal thickness. The accurate thickness measurements were used to construct detailed pachymetry maps. Moreover, follow-up scans could be registered based on anatomical landmarks to obtain differential pachymetry maps. These maps may enable a more comprehensive understanding of the restoration of the endothelial function after DMEK, where thickness often varies throughout different regions of the cornea, and subsequently contribute to a standardized postoperative regime.
The classical models of Hertz, Sneddon and Boussinesq provide solutions for problems of indentation of a semi-infinite elastic massif by a sphere, a sphere or a cone and a flat punch. Although these models have been widely tested, it appears that at
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