Principal Component Analysis of a Real-World Cohort of Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty Cases: Demonstration of a Powerful Data-Mining Technique for Identifying Areas of Research.
Journal
Cornea
ISSN: 1536-4798
Titre abrégé: Cornea
Pays: United States
ID NLM: 8216186
Informations de publication
Date de publication:
29 May 2024
29 May 2024
Historique:
received:
12
01
2024
accepted:
24
04
2024
medline:
3
6
2024
pubmed:
3
6
2024
entrez:
3
6
2024
Statut:
aheadofprint
Résumé
Principal component analysis (PCA) is a descriptive exploratory statistical technique that is widely used in complex fields for data mining. However, it is rarely used in ophthalmology. We explored its research potential with a large series of eyes that underwent 3 keratoplasty techniques: Descemet membrane endothelial keratoplasty (DMEK), conventional Descemet stripping automated endothelial keratoplasty (ConDSAEK), or ultrathin-DSAEK (UT-DSAEK). All consecutive DMEK/DSAEK cases conducted in 2016 to 2022 that had ≥24 months of follow-up were included. ConDSAEK and UT-DSAEK were defined as preoperative central graft thickness ≥130 and <130 μm, respectively. Seventy-six patient, disease, surgical practice, and temporal outcome variables were subjected to PCA, including preoperative anterior keratometry, the use of sulfur hexafluoride gas (SF6) versus air for primary tamponade, and postoperative best corrected visual acuity and endothelial cell density. Associations of interest that were revealed by PCA were assessed with the Welch t test or Pearson test. A total of 331 eyes were treated with DMEK (n = 165), ConDSAEK (n = 95), or UT-DSAEK (n = 71). PCA showed that ConDSAEK and UT-DSAEK clustered closely, including regarding postoperative best corrected visual acuity, and were clearly distinct from DMEK. PCA and follow-up univariate analyses suggested that in DMEK, 1) flatter preoperative anterior keratometry (average, K1, and K2) associated with more rebubbling (P = 0.004-0.089) and graft detachment (P = 0.007-0.022); 2) graft marking did not affect postoperative ECD; and 3) lower postoperative endothelial cell density associated with SF6 use (all P > 0.001) and longer surgery (P = 0.005-0.091). All associations are currently under additional investigation in our hospital. PCA is a powerful technique that can rapidly reveal clinically relevant associations in complex ophthalmological datasets.
Identifiants
pubmed: 38830189
doi: 10.1097/ICO.0000000000003584
pii: 00003226-990000000-00569
doi:
Banques de données
ClinicalTrials.gov
['NCT04424550']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
Références
Jolliffe IT, Cadima J. Principal component analysis: a review and recent developments. Philos Trans A Math Phys Eng Sci. 2016;374:20150202.
Kim S, Kang D, Huo Z, et al. Meta-analytic principal component analysis in integrative omics application. Bioinformatics. 2018;34:1321–1328.
Melles GR, Eggink FA, Lander F, et al. A surgical technique for posterior lamellar keratoplasty. Cornea. 1998;17:618–626.
Melles GRJ, Ong TS, Ververs B, et al. Descemet membrane endothelial keratoplasty (DMEK). Cornea. 2006;25:987–990.
Guechi O, Lhuillier L, Houmad N, et al. Visual outcomes following Descemet stripping automated endothelial keratoplasty for corneal endothelial dysfunction. Eur J Ophthalmol. 2017;27:513–519.
Melles GRJ, Ong TS, Ververs B, et al. Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2008;145:222–227.
Price MO, Giebel AW, Fairchild KM, et al. Descemet's membrane endothelial keratoplasty: prospective multicenter study of visual and refractive outcomes and endothelial survival. Ophthalmology. 2009;116:2361–2368.
Chen ES, Terry MA, Shamie N, et al. Precut tissue in Descemet's stripping automated endothelial keratoplasty. Donor characteristics and early postoperative complications. Ophthalmology. 2008;115:497–502.
Marques RE, Guerra PS, Sousa DC, et al. DMEK versus DSAEK for Fuchs' endothelial dystrophy: a meta-analysis. Eur J Ophthalmol. 2019;29:15–22.
Koo EH, Pineda R, Afshari N, et al. Learning Descemet membrane endothelial keratoplasty: a survey of U.S. Corneal surgeons. Cornea. 2020;39:590–593.
Gerber-Hollbach N, Baydoun L, López EF, et al. Clinical outcome of rebubbling for graft detachment after Descemet membrane endothelial keratoplasty. Cornea. 2017;36:771–776.
Hayashi T, Schrittenlocher S, Siebelmann S, et al. Risk factors for endothelial cell loss after Descemet membrane endothelial keratoplasty (DMEK). Sci Rep. 2020;10:11086–11089.
Dunker S, Winkens B, Van Den Biggelaar F, et al. Rebubbling and graft failure in Descemet membrane endothelial keratoplasty: a prospective Dutch registry study. Br J Ophthalmol. 2023;107:17–23.
Vasiliauskaitė I, Quilendrino R, Baydoun L, et al. Effect of six-month postoperative endothelial cell density on graft survival after Descemet membrane endothelial keratoplasty. Ophthalmology. 2021;128:1689–1698.
Busin M, Patel AK, Scorcia V, et al. Microkeratome-assisted preparation of ultrathin grafts for Descemet stripping automated endothelial keratoplasty. Invest Ophthalmol Vis Sci. 2012;53:521–524.
Busin M, Madi S, Santorum P, et al. Ultrathin Descemet's stripping automated endothelial keratoplasty with the microkeratome double-pass technique: two-year outcomes. Ophthalmology. 2013;120:1186–1194.
Mencucci R, Favuzza E, Marziali E, et al. Ultrathin Descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a fellow-eye comparison. Eye Vis. 2020;7:25.
Neff KD, Biber JM, Holland EJ. Comparison of central corneal graft thickness to visual acuity outcomes in endothelial keratoplasty. Cornea. 2011;30:388–391.
Dickman MM, Kruit PJ, Remeijer L, et al. A randomized multicenter clinical trial of ultrathin Descemet stripping automated endothelial keratoplasty (DSAEK) versus DSAEK. Ophthalmology 2016;123:2276–2284.
Droutsas K, Petrelli M, Miltsakakis D, et al. Visual outcomes of ultrathin-Descemet stripping endothelial keratoplasty versus Descemet stripping endothelial keratoplasty. J Ophthalmol. 2018;2018:5924058.
Dunker SL, Dickman MM, Wisse RPL, et al. Descemet membrane endothelial keratoplasty versus ultrathin Descemet stripping automated endothelial keratoplasty: a multicenter randomized controlled clinical trial. Ophthalmology. 2020;127:1152–1159.
Madi S, Leon P, Nahum Y, et al. Five-year outcomes of ultrathin Descemet stripping automated endothelial keratoplasty. Cornea. 2019;38:1192–1197.
Bhandari V, Reddy JK, Relekar K, et al. Descemet's stripping automated endothelial keratoplasty versus Descemet's membrane endothelial keratoplasty in the fellow eye for Fuchs endothelial dystrophy: a retrospective study. Biomed Res Int. 2015;2015:750567.
Chamberlain W, Lin CC, Austin A, et al. Descemet endothelial thickness comparison trial: a randomized trial comparing ultrathin Descemet stripping automated endothelial keratoplasty with Descemet membrane endothelial keratoplasty. Ophthalmology 2019;126:19–26.
Matsou A, Pujari R, Sarwar H, et al. Microthin descemet stripping automated endothelial keratoplasty versus Descemet membrane endothelial keratoplasty: a randomized clinical trial. Cornea. 2021;40:1117–1125.
Stuart AJ, Romano V, Virgili G, et al. Descemet's membrane endothelial keratoplasty (DMEK) versus Descemet's stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure. Cochrane Database Syst Rev. 2018;6:CD012097.
Marques RE, Guerra PS, Sousa DC, et al. Sulfur hexafluoride 20% versus air 100% for anterior chamber tamponade in DMEK: a meta-analysis. Cornea. 2018;37:691–697.
Bachmann BO, Laaser K, Cursiefen C, et al. A method to confirm correct orientation of Descemet membrane during Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2010;149:922–925.e2.
Bhogal M, Maurino V, Allan BD. Use of a single peripheral triangular mark to ensure correct graft orientation in Descemet membrane endothelial keratoplasty. J Cataract Refract Surg. 2015;41:2022–2024.
Matsuzawa A, Hayashi T, Oyakawa I, et al. Use of four asymmetric marks to orient the donor graft during Descemet's membrane endothelial keratoplasty. BMJ Open Ophthalmol. 2017;1:e000080.
Terry MA, Straiko MD, Veldman PB, et al. Standardized DMEK technique: reducing complications using prestripped tissue, novel glass injector, and sulfur hexafluoride (SF6) gas. Cornea. 2015;34:845–852.
Veldman PB, Dye PK, Holiman JD, et al. Stamping an S on DMEK donor tissue to prevent upside-down grafts: laboratory validation and detailed preparation technique description. Cornea. 2015;34:1175–1178.
Perone J-M, Goetz C, Zevering Y, et al. Graft thickness at 6 months postoperatively predicts long-term visual acuity outcomes of Descemet stripping automated endothelial keratoplasty for Fuchs dystrophy and moderate phakic bullous keratopathy: a cohort study. Cornea. 2022;41:1362–1371.
Bloch F, Dinot V, Goetz C, et al. Ability of routinely collected clinical factors to predict good visual results after primary Descemet membrane endothelial keratoplasty: a cohort study. BMC Ophthalmol. 2022;22:350.
Perone JM, Goetz C, Zaidi M, et al. Supracapsular phacoemulsification: description of the “Garde à vous” technique and comparative clinical results. J Fr Ophtalmol. 2019;42:597–602.
Schrittenlocher S, Bachmann B, Tiurbe AM, et al. Impact of preoperative visual acuity on Descemet membrane endothelial keratoplasty (DMEK) outcome. Graefes Arch Clin Exp Ophthalmol. 2019;257:321–329.
Vasiliauskaitė I, Quilendrino R, Baydoun L, et al. Effect of six-month postoperative endothelial cell density on graft survival after Descemet membrane endothelial keratoplasty. Ophthalmology. 2021;128:1689–1698.
Inoda S, Hayashi T, Takahashi H, et al. Factors associated with endothelial cell density loss post Descemet membrane endothelial keratoplasty for bullous keratopathy in Asia. PLoS One. 2020;15:e0234202.
Marques RE, Guerra PS, Sousa DC, et al. Sulfur hexafluoride 20% versus air 100% for anterior chamber tamponade in DMEK: a meta-analysis. Cornea. 2018;37:691–697.
Landry H, Aminian A, Hoffart L, et al. Corneal endothelial toxicity of air and SF6. Invest Ophthalmol Vis Sci. 2011;52:2279–2286.
Hesse M, Kuerten D, Walter P, et al. The effect of air, SF6 and C3F8 on immortalized human corneal endothelial cells. Acta Ophthalmol. 2017;95:e284–e290.
Diab RA, Zarei-ghanavati M, Bardan AS, et al. Preferred practices of Descemet's Membrane Endothelial Keratoplasty (DMEK) surgeons in the UK: a national survey. J EuCornea. 2022;11:1–7.
Chaussard D, Bloch F, Elnar AA, et al. Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: a retrospective cohort study. PLoS One. 2022;17:e0264401–e0264418.
Veldman PB, Dye PK, Holiman JD, et al. The S-stamp in Descemet membrane endothelial keratoplasty safely eliminates upside-down graft implantation. Ophthalmology. 2016;123:161–164.
Stoeger C, Holiman J, Davis-Boozer D, et al. The endothelial safety of using a gentian violet dry-ink “S” stamp for precut corneal tissue. Cornea. 2012;31:801–803.
Neiter E, Sot M, Lhuillier L, et al. Relationship between preoperative corneal thickness and postoperative visual outcomes after posterior lamellar corneal transplant. Int J Ophthalmic Pathol. 2019;8:1.