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B-scan ultrasound, visual electrophysiology and perioperative videoendoscopy for predicting functional results in keratoprosthesis candidates
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  • Published on:
    B-scan ultrasound, visual electrophysiology and perioperative videoendoscopy for predicting functional results in keratoprosthesis candidates
    • Lauro A. OLIVEIRA, Affiliate Professor at Department of Ophthalmology and Visual Sciences - Federal University of São Paulo - Brazil Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Brazil
    • Other Contributors:
      • Luzia D. Silva, Medical assistant at the Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Brazil
      • Flavio E. Hirai, Head of Ocular External Diseases and Cornea - Department of Ophthalmology and Visual Sciences, Federal University of São Paulo,
      • Norma Allemann, Adjunct Professor at Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Brazil
      • Adriana Berezovsky, Adjunct Professor at Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Brazil
      • Solange R. Salomão, Adjunct Professor at Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Brazil
      • Paulo R. C. Oliveira, Ophthalmologist
      • Gabriel C. Andrade, Ophthalmologist
      • Andre Maia, Ophthalmologist
      • Luciene B. Sousa, Ophthalmologist

    Luzia Diegues Silva MD1, Albert Santos MD1, Flávio Eduardo Hirai MD. Ph.D1, Norma Allemann MD1,2, Adriana Berezovsky Ph.D1, Solange Rios Salomão Ph.D1, Paulo Ricardo Chaves de Oliveira MD1, Gabriel Costa de Andrade MD1, Andre Maia MD1, Luciene Barbosa de Sousa MD1, Lauro Augusto de Oliveira MD. Ph.D.1,*

    1 Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, Brazil
    2 Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
    Corresponding author: Lauro Augusto de Oliveira

    Dear Editor,

    We read with interest the comments about our article by Anchouche and associates.

    We agree with the authors that B-scan ultrasonography is widely accepted as the gold-standard preoperative imaging modality used to assess the posterior segment in eyes with severe and dense anterior segment opacities and it has been proven to be a useful tool in the preoperative evaluation of Kpro candidates. We also agree that it is safer, cheaper and a less invasive procedure when compared to VE. However, this image modality offers mostly anatomical information and less functional prognosis prediction when compared to direct visualization of the posterior segment achieved with VE.[1]

    We are aware and agree with the authors’ concern regarding the invasive nature, the risk of elevated intraocular pressure, and cataract formation as discussed in our work. However, as it is clearly described in our manuscript,...

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    Conflict of Interest:
    None declared.
  • Published on:
    B-scan ultrasound, visual electrophysiology and perioperative videoendoscopy for predicting functional results in keratoprosthesis candidates
    • Sonia Anchouche, MD Candidate Faculty of Medicine, McGill University, Montreal, QC, Canada
    • Other Contributors:
      • Mona Harissi-Dagher, Chief of Cornea Service and Full Professor

    Dear Editor,

    We read with interest the study by Silva and colleagues.[1] The authors investigate the prognostic potential of B-scan ultrasonography, visual electrophysiology and perioperative videoendoscopy (VE) for 13 patients undergoing keratoprosthesis (KPro) surgery and identified perioperative intraocular VE as a predictor of functional visual outcome at 1-year follow-up.[1] While we find this study interesting, we would like to caution against the interpretation and over-generalization of the findings reported therein.

    Negative predictive value (NPV) was as defined as the number of patients with abnormal VE findings and subsequent unsatisfactory visual acuity over all patients with unfavourable VE. The authors report a NPV of 50% in 10 patients. By contrast, they report a positive predictive value (PPV) of 100% for this test.[1] Although a high PPV, as reported by the authors, is of great importance when deciding which patients are appropriate KPro candidates preoperatively, once the patient is undergoing surgery, we believe identifying patients at highest risk of poor visual outcome using NPV is more clinically relevant. The small sample size of 10 patients with a low prevalence of patients with unsatisfactory post-operative visual acuity, and NPV of 50% are important limitations of this study. From these findings, we are unable to justify VE's clinical benefit to the surgeon and their patient at the time of surgery. This is especially true give...

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    Conflict of Interest:
    None declared.