fr
Article scientifique
Anglais

Optimization of surgical parameters based on patient-specific models: application to arcuate keratotomy

Publié dansJournal of Cataract & Refractive Surgery, vol. 45, no. 8, p. 1084-1091
Date de publication2019
Résumé

Purpose: To determine surgical parameters for arcuate keratotomy by simulating the intervention with a patient-specific model. Setting: University Eye Clinic Salzburg, Paracelsus Medical University, Austria, and Institute for Surgical Technology and Biomechanics, University of Bern, Switzerland. Design: Computational modeling study. Methods: A new approach to plan arcuate keratotomy based on personalized finite element simulations was developed. Using this numeric tool, an optimization algorithm was implemented to determine the incision parameters that best met the surgeon's requirements while preserving the orientation of the astigmatism. Virtual surgeries were performed on patients to compare the performance of the simulation-based approach with results based on the Lindstrom and Donnenfeld nomograms and with intrastromal interventions. Results: Retrospective data on 28 patients showed that personalized simulation reproduced the surgically induced change in astigmatism (Pearson correlation = 0.8). Patient-specific simulation was used to examine strategies for arcuate interventions on 621 corneal topographies. The Lindstrom nomogram resulted in low postoperative astigmatism (mean 0.03 diopter [D] +/- 0.3 [SD]) but frequent overcorrections (20%). The Donnenfeld nomogram and intrastromal incisions resulted in a small amount of overcorrection (1.5%) but a wider spread in astigmatism (mean 0.63 +/- 0.35 D and 0.48 +/- 0.50 D, respectively). In contrast, the new numeric parameter optimization approach led to postoperative astigmatism values (mean 0.40 +/- 0.08 D, 0.20 +/- 0.08 D, and 0.04 +/- 0.13 D) that closely matched the target astigmatism (0.40 D, 0.20 D, and 0.00 D), respectively, while keeping the number of overcorrections low (<1.5%). Conclusion: Using numeric modeling to optimize surgical parameters for arcuate keratotomy led to more reliable postoperative astigmatism, limiting the risk for overcorrection. (C) 2019 ASCRS and ESCRS

Mots-clés
  • TEMPORAL CLEAR CORNEAL
  • RELAXING INCISIONS
  • ASTIGMATISM
  • PHACOEMULSIFICATION
  • SIMULATION
  • SUPERIOR
  • VIVO
Citation (format ISO)
TRUFFER, Oskar et al. Optimization of surgical parameters based on patient-specific models: application to arcuate keratotomy. In: Journal of Cataract & Refractive Surgery, 2019, vol. 45, n° 8, p. 1084–1091. doi: 10.1016/j.jcrs.2019.02.022
Fichiers principaux (1)
Article (Published version)
accessLevelRestricted
Identifiants
ISSN du journal0886-3350
194vues
0téléchargements

Informations techniques

Création23.09.2020 10:35:00
Première validation23.09.2020 10:35:00
Heure de mise à jour15.03.2023 22:39:37
Changement de statut15.03.2023 22:39:36
Dernière indexation17.01.2024 10:58:07
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack