Zhang Weijie, Li Fang, Li Lin, Zhang Jing
Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
Front Neurol. 2023 Mar 3;14:1136579. doi: 10.3389/fneur.2023.1136579. eCollection 2023.
Appropriate vault height of implantable collamer lens (ICL) implantation matters for it has risks of corneal endothelial cell loss, cataract formation and intraocular pressure elevation, which could lead to irreversible damage to optic nerve. Therefore, pre-operative prediction for an ideal vault height is a hotspot. However, few data exist regarding quantitative effect of ICL orientation on vault height. This study is aimed to quantitatively investigate the effect of ICL implantation orientation on vault height, and built a machine-learning (ML)-based vault prediction model taking implantation orientation into account.
473 consecutive case series treated with ICL implantation were retrospectively analyzed (408 were horizontally implanted, and 65 were vertically implanted). Multivariable logistic regression analysis was performed to determine the association between ICL orientation and achieved vault. ML was performed to develop a new vault height prediction model taking ICL orientation into account. Receiver operating characteristic curve (ROC) and net reclassification index (NRI) were obtained to assess the prediction ability.
95% of all the patients achieved 20/20 uncorrected distance visual acuity (UDVA) or better. No complications including cataract formation, dispersion or optic nerve injury were observed in any cases. Sex, sphere power, cylinder power, axis, ICL size and ICL orientation were all significant risk factors associated to vault height, and age was positively co-related. Of note, ICL size and ICL orientation were the top-ranking risk factors. Comparing to conventional horizontal implantation, vertical implantation could reduce the achieved vault by 81.187 μm ( < 0.001). In regarding to different ICL sizes, vertical implantation had no good to vault reduction when using ICL of 12.1 mm. However, it could reduce the vault by 59.351 μm and 160.992 μm respectively when ICL of 12.6mm and 13.2 mm were implanted ( = 0.0097 and = 0.0124). For prediction of vault height, ML based model significantly outperformed traditional multivariable regression model.
We provide quantitative evidence that vertical implantation of ICL could effectively reduce the achieved vault height, especially when large size ICL was implanted, comparing to traditional horizontal implantation. ML is extremely applicable in development of vault prediction model.
可植入式角膜接触镜（ICL）植入时合适的房水腔高度至关重要，因为存在角膜内皮细胞丢失、白内障形成和眼压升高的风险，这些可能导致视神经不可逆损伤。因此，术前预测理想的房水腔高度是一个热点。然而，关于ICL植入方向对房水腔高度的定量影响的数据很少。本研究旨在定量研究ICL植入方向对房水腔高度的影响，并建立一个考虑植入方向的基于机器学习（ML）的房水腔预测模型。
回顾性分析473例连续接受ICL植入治疗的病例系列（408例水平植入，65例垂直植入）。进行多变量逻辑回归分析以确定ICL植入方向与所达到的房水腔之间的关联。采用机器学习建立一个考虑ICL植入方向的新房水腔高度预测模型。获得受试者工作特征曲线（ROC）和净重新分类指数（NRI）以评估预测能力。
所有患者中有95%达到20/20或更好的未矫正远视力（UDVA）。所有病例均未观察到包括白内障形成、散光或视神经损伤在内的并发症。性别、球镜度数、柱镜度数、轴位、ICL尺寸和ICL植入方向均是与房水腔高度相关的显著危险因素，年龄呈正相关。值得注意的是，ICL尺寸和ICL植入方向是首要危险因素。与传统水平植入相比，垂直植入可使所达到的房水腔高度降低81.187μm（P<0.001）。对于不同尺寸的ICL，使用12.1mm的ICL时垂直植入对降低房水腔高度效果不佳。然而，当植入12.6mm和13.2mm的ICL时，垂直植入可分别使房水腔高度降低59.351μm和160.992μm（P=0.0
