使用术中光相干断层扫描对撕囊自动角膜内皮移植术中界面液进行自动容积分析。
Automated volumetric analysis of interface fluid in descemet stripping automated endothelial keratoplasty using intraoperative optical coherence tomography.
机构信息
Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, United States Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States.
Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States.
出版信息
Invest Ophthalmol Vis Sci. 2014 Aug 7;55(9):5610-5. doi: 10.1167/iovs.14-14346.
PURPOSE
We demonstrated a novel automated algorithm for segmentation of intraoperative optical coherence tomography (iOCT) imaging of fluid interface gap in Descemet stripping automated endothelial keratoplasty (DSAEK) and evaluated the effect of intraoperative maneuvers to promote graft apposition on interface dimensions.
METHODS
A total of 30 eyes of 29 patients from the anterior segment arm of the PIONEER study was included in this analysis. The iOCT scans were entered into an automated algorithm that delineated the spatial extent of the fluid interface gap in three dimensions between donor and host cornea during surgery. The algorithm was validated against manual segmentation, and performance was evaluated by absolute accuracy and intraclass correlation coefficient. Patients underwent DSAEK using a standard sequence of maneuvers, including controlled elevation of IOP and compressive corneal sweep to promote graft adhesion. Measurement of interface fluid volume, en face area, and maximal interface height were compared between scans before anterior chamber infusion, after pressure elevation alone, and after corneal sweep with pressure elevation using dependent-samples t-test.
RESULTS
The algorithm achieved 87% absolute accuracy and an intraclass correlation of 0.96. Nine datasets of a total of 84 (11%) required human correction of segmentation errors. Mean interface fluid volume was significantly decreased by corneal sweep (P = 0.021) and by both maneuvers combined (P = 0.046). Mean en face area was significantly decreased by corneal sweep (P = 0.010) and the maneuvers combined (P < 0.001). Maximal interface height was significantly decreased by pressure elevation (P = 0.010), corneal sweep (P = 0.009), and the maneuvers combined (P = 0.010).
CONCLUSIONS
Quantitative analysis of iOCT volumetric scans shows the significant effect of controlled pressure elevation and corneal sweep on graft apposition in DSAEK. Computerized iOCT analysis yields objective measurements of interface fluid intraoperatively, which provides information on anatomic outcomes and could be used in future trials.
目的
我们展示了一种新的自动算法，用于分割在撕囊自动化角膜内皮移植术（Descemet stripping automated endothelial keratoplasty，DSAEK）中术中光学相干断层扫描（intraoperative optical coherence tomography，iOCT）成像的流体界面间隙，并评估了促进移植物贴合的术中操作对界面尺寸的影响。
方法
本分析纳入了 PIONEER 研究前节部分的 29 例 30 只眼。iOCT 扫描输入到一个自动算法中，该算法在手术过程中在三维空间上描绘供体和宿主角膜之间的流体界面间隙的空间范围。该算法与手动分割进行了验证，并通过绝对准确性和组内相关系数评估了性能。患者接受了 DSAEK 手术，采用了包括控制眼压升高和角膜压缩扫掠以促进移植物附着的标准操作序列。使用独立样本 t 检验比较前房灌注前、单独眼压升高后和角膜扫掠联合眼压升高后的界面流体体积、平面面积和最大界面高度的测量值。
结果
该算法的绝对准确性为 87%，组内相关系数为 0.96。在总共 84 个（11%）数据集的 9 个数据集中，需要人工纠正分割错误。角膜扫掠（P = 0.021）和两种操作联合（P = 0.046）均显著降低了界面流体体积。角膜扫掠（P = 0.010）和两种操作联合（P < 0.001）均显著降低了平面面积。眼压升高（P = 0.010）、角膜扫掠（P = 0.009）和两种操作联合（P = 0.010）均显著降低了最大界面高度。
结论
iOCT 容积扫描的定量分析显示，控制眼压升高和角膜扫掠对 DSAEK 中移植物贴合的显著影响。计算机化的 iOCT 分析可在术中提供界面流体的客观测量值，这些信息可用于评估解剖学结果，并可用于未来的试验。
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