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

Truffer, Oskar; Abler, Daniel; Pajic, Bojan; Grabner, Günther; Kraker, Hannes; Büchler, Philippe (2019). Optimization of surgical parameters based on patient-specific models: Application to arcuate keratotomy. Journal of cataract and refractive surgery, 45(8), pp. 1084-1091. Elsevier 10.1016/j.jcrs.2019.02.022

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute for Surgical Technology & Biomechanics ISTB [discontinued]
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Musculoskeletal Biomechanics

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Truffer, Oskar; Abler, Daniel and Büchler, Philippe

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health
600 Technology > 620 Engineering

ISSN:

0886-3350

Publisher:

Elsevier

Language:

English

Submitter:

Philippe Büchler

Date Deposited:

18 Dec 2019 15:46

Last Modified:

20 Dec 2019 15:46

Publisher DOI:

10.1016/j.jcrs.2019.02.022

PubMed ID:

31371005

BORIS DOI:

10.7892/boris.135575

URI:

https://boris.unibe.ch/id/eprint/135575

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