Early Corneal and Epithelial Remodeling Differences Identified by OCT Imaging and Artificial Intelligence Between Two Transepithelial PRK Platforms

Abstract

PURPOSE: To analyze corneal and epithelial remodeling differences between SmartSurfACE reverse transepithelial PRK (SCHWIND eye-tech-solutions) and Streamlight (Alcon Laboratories, Inc) transepithelial PRK procedure using optical coherence tomography (OCT) and artificial intelligence (AI). METHODS: This was a prospective, interventional, and longitudinal study. A contralateral eye study was conducted in which one eye was assigned to the SmartSurfACE group and the fellow eye was assigned to the Streamlight group. OCT was performed preoperatively and 1, 3, and 6 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity and residual refractive error was measured only preoperatively and at 3 and 6 months. From OCT, curvature and aberrations of the air–epithelium (A–E) interface, epithelium–Bowman's layer (E-B) interface, and epithelium Zernike indices (EZI) were derived. Pain was evaluated at 1 day postoperatively using the Wong-Baker scale. RESULTS: Both groups had similar UDVA, CDVA, residual refractive error, and changes in A–E and E-B curvatures at 3 and 6 months postoperatively ( P > .05). However, many parameters indicated that the Streamlight group underwent a greater change in A–E aberrations, E-B aberrations, and EZI than the SmartSurfACE group postoperatively ( P < .05). The EZI indicated a greater level of epithelial thickness distortion in the Streamlight group than in the SmartSurfACE group ( P < .05). Using AI, the EZI were most indicative of remodeling differences between the two groups. Further, the pain was significantly greater at 1 day in the Streamlight group ( P < .05). CONCLUSIONS: Early remodeling differences existed because the Streamlight procedure removed a greater amount of epithelium than the SmartSurfACE procedure. However, the visual and refractive outcomes were comparable. [ J Refract Surg . 2020;36(10):678–686.]

Keratoconus: exploring fundamentals and future perspectives – a comprehensive systematic review

“…There is no universally accepted staging system for KC; however, significant advances in artificial intelligence in recent years can help identify the proper indications for surgery. 14 Pachymetric 41 and tomographic indices 42 integrate with biomechanical evaluation of cornea, 43 anterior corneal higher order aberrations (HOAs), 44 and ultra-high-resolution Optical Coherence Tomography (OCT) 45 not only use preoperatively, but also for postoperative (epithelial remodeling 46 and anterior stromal demarcation) management. 47 Furthermore, regarding genetic aspects 3 , 7 and metabolic imbalance of the disease, 48 recent reviews considered that micronutrients such as metal ions, vitamins, hormones, antioxidants, oral riboflavin, and Essential Fatty Acids, can deeply influence KC initiation and progression, particularly in the early stages of KC.…”

Mapping of corneal birefringence in thin and asymmetric keratoconus corneas with ultrahigh-resolution polarization-sensitive OCT

“…21 The 3D distribution of epithelium quantified with epithelial Zernike indices and total corneal thickness were also computed from the exported comma-separated value files of MS-39. 22 From Corvis-ST, the Corvis biomechanical index (CBI), total biomechanical index (TBI) and Belin-Ambrósio overall deviation index (BAD-D) were analyzed. Patient demographics included age, sphere, cylinder, and uncorrected and corrected distance visual acuities.…”

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“…Laser platforms and surgical techniques can also alter this epithelial thickness change. Shetty et al [ 157 ] showed higher degrees of epithelial thickness distortion in the Streamlight group than in the SmartSurfACE one. Lu et al [ 158 ] investigated the effect of mitomycin-C (MMC) in epithelial remodeling.…”