Refractive Coupling Effects in Keratorefractive Lenticule Extraction Procedures: A Machine Learning-Assisted Approach.

IF 2.9 3区医学 Q1 OPHTHALMOLOGY Journal of refractive surgery Pub Date : 2024-10-01 DOI:10.3928/1081597X-20240826-01

Soodabeh Darzi, Samuel Arba-Mosquera, Kishore Raj Pradhan, Anika Förster, H Burkhard Dick, Suphi Taneri

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Abstract

Purpose: To evaluate the impact of refractive couplings in myopia and myopic astigmatism with two different keratorefractive lenticule extraction (KLEx) systems.

Methods: This was a retrospective evaluation of refractive outcomes with two different lasers studying 2,841 eyes undergoing small incision lenticule extraction (SMILE) (VisuMax 500; Carl Zeiss Meditec) and 2,528 eyes undergoing SmartSight (ATOS; SCHWIND eye-tech-solutions GmbH). Coupling effects (derived from the ratio between partial slopes) were determined for sphere and cylinder and for spherical equivalent, cardinal, and oblique astigmatism separately.

Results: Statistically significant coupling effects were observed for both the VisuMax and ATOS systems, as indicated by P values less than .05. For the VisuMax, a coupling effect of 8% of cylinder into sphere and a 2% coupling of sphere into cylinder was found. For the ATOS, the coupling effect of sphere into cylinder was 1%. A 3% coupling effect of oblique astigmatism into cardinal astigmatism in the VisuMax, and conversely, a 0.1% coupling effect of defocus into oblique astigmatism in the ATOS were found. In cases with no astigmatism plan, sphere had a 2% effect on induced astigmatism in the VisuMax and 0.6% in the ATOS. In high astigmatism plans, sphere had a significant 16% impact on cylinder in the VisuMax. Additionally, the effect of defocus on cardinal astigmatism was 6% in the VisuMax and 0.8% on oblique astigmatism in the ATOS.

Conclusions: Despite the P values less than .05 indicating statistical significance, the observed coupling effects were consistently low, with magnitudes below 10%, even for astigmatism exceeding 2.50 diopters. These couplings may be partly attributed to cross-effects of torsional eye movements. Coupling values for KLEx were markedly lower than those reported for non-aspheric excimer laser ablations. The results suggest that surgical results may be refined further by optimizing nomograms to mitigate coupling effects. [J Refract Surg. 2024;40(10):e706-e715.].

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角膜屈光性皮孔提取术中的屈光耦合效应：机器学习辅助方法。

目的：评估两种不同的角膜屈光性皮瓣摘除术（KLEx）系统的屈光耦合对近视和近视散光的影响：这是一项对两种不同激光屈光结果的回顾性评估，对2841只眼睛进行了小切口光阑摘除术（SMILE）（VisuMax 500; Carl Zeiss Meditec），对2528只眼睛进行了SmartSight（ATOS; SCHWIND eye-tech-solutions GmbH）。分别测定了球面和柱面的耦合效应（由部分斜率之间的比值得出），以及球面等效、红心和斜散光的耦合效应：结果：VisuMax 和 ATOS 系统的耦合效应均具有统计学意义，P 值小于 0.05。在 VisuMax 系统中，圆柱体与球体的耦合效应为 8%，球体与圆柱体的耦合效应为 2%。在 ATOS 系统中，球体与圆柱体的耦合效应为 1%。在 VisuMax 中，斜散光与心散光的耦合效应为 3%，反之，在 ATOS 中，散焦与斜散光的耦合效应为 0.1%。在无散光计划的情况下，VisuMax 中球面对诱发散光的影响为 2%，ATOS 中为 0.6%。在高散光计划中，VisuMax 中球面对柱面有 16% 的显著影响。此外，在 VisuMax 中，散焦对心散光的影响为 6%，在 ATOS 中，散焦对斜散光的影响为 0.8%：尽管 P 值小于 0.05 表明统计意义显著，但观察到的耦合效应始终较低，即使散光超过 2.50 度，耦合效应也低于 10%。这些耦合效应可能部分归因于眼球扭转运动的交叉效应。KLEx 的耦合值明显低于非天球准分子激光消融的耦合值。结果表明，可以通过优化提名图来减轻耦合效应，从而进一步完善手术结果。[J Refract Surg. 2024;40（10）：e706-e715]。

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来源期刊

$Journal of refractive surgery$

Journal of refractive surgery 医学-外科

CiteScore

5.10

自引率

12.50%

发文量

160

审稿时长

4-8 weeks

期刊介绍： The Journal of Refractive Surgery, the official journal of the International Society of Refractive Surgery, a partner of the American Academy of Ophthalmology, has been a monthly peer-reviewed forum for original research, review, and evaluation of refractive and lens-based surgical procedures for more than 30 years. Practical, clinically valuable articles provide readers with the most up-to-date information regarding advances in the field of refractive surgery. Begin to explore the Journal and all of its great benefits such as: • Columns including “Translational Science,” “Surgical Techniques,” and “Biomechanics” • Supplemental videos and materials available for many articles • Access to current articles, as well as several years of archived content • Articles posted online just 2 months after acceptance.