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Cornea and ocular surface
Predicting visual outcomes in keratoprosthesis surgery with critical flicker fusion frequency, B-scan, visual electrophysiology and endoscopy
  1. Guangcan Xu1,2,
  2. Haolan Qi1,2,
  3. Qianwei He1,2,
  4. Mingxiong Chen1,2,
  5. Junxia Fu3,
  6. Qun Wang2,
  7. Biyue Chen2,4,
  8. Qing Hua Yang2,
  9. Yifei Huang2,4,
  10. Shihui Wei2,4,
  11. Liqiang Wang1,2,4
  1. 1School of Medicine, Nankai University, Tianjin, China
  2. 2Department of Ophthalmology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
  3. 3Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
  4. 4Medical School of Chinese PLA, Beijing, China
  1. Correspondence to Dr Liqiang Wang; liqiangw301{at}163.com; Professor Shihui Wei; weishihui{at}301hospital.com.cn

Abstract

Purpose This study evaluates the predictive power of the critical flicker fusion frequency (CFF) test for visual outcomes in keratoprosthesis (KPro) candidates, comparing its accuracy with B-scan ultrasound, flash visual evoked potentials (fVEP) and endoscopy.

Methods The study included 42 patients (42 eyes) scheduled for KPro surgery with a median follow-up period of 6 months. The receiver operating characteristic curve identified the cut-off threshold for CFF in the model development study (17 eyes). All patients in the comparison study (25 eyes) underwent preoperative assessments including trichromatic CFF (red, green and yellow), B-scan ultrasound, fVEP and perioperative endoscopy. Results were classified as either favourable or unfavourable predictors of visual outcomes based on predefined criteria. Sensitivity and specificity of each assessment were calculated based on postoperative best-corrected visual acuity (BCVA)≥20/200. The Bland-Altman test assessed the consistency between CFF-predicted BCVA and actual BCVA.

Results Among the trichromatic CFF tests, the yellow-CFF (yCFF) exhibited the highest area under the curve value of 0.97 and a cut-off threshold at 10 Hz for predicting postoperative BCVA≥20/200 (p<0.05). yCFF achieved 90% sensitivity and 80% specificity in predicting satisfactory postoperative outcomes. Endoscopy had 80% sensitivity and 80% specificity, B-scan showed 70% sensitivity and 60% specificity, and fVEP had 75% sensitivity and 40% specificity. yCFF showed a mean bias of 0.091 logarithm of the minimum angle of resolution (logMAR) in postoperative prediction.

Conclusions The CFF test provides robust visual function evaluation in KPro candidates. It demonstrates superior predictive accuracy for visual prognosis compared with routine ophthalmologic examinations, such as B-scan ultrasonography, fVEP and endoscopy.

  • Cornea
  • Ocular surface
  • Optic Nerve

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

https://doi.org/10.1136/bjo-2024-325719

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information.

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    Footnotes

    • GX, HQ and QH contributed equally.

    • Contributors GX: conceptualisation, data curation, formal analysis, investigation, methodology, project administration, roles/writing–original draft, writing–review and editing. HQ: formal analysis, data curation, investigation, methodology, roles/writing–original draft, writing–review and editing. QH: formal analysis, project administration, software, validation. MC: investigation, software. JF: investigation, data curation. QW: investigation, methodology, validation. BC: formal analysis, data curation. QHY: formal analysis, resources, data curation. YH: methodology, project administration. SW: conceptualisation, project administration, supervision. LW: conceptualisation, project administration, supervision, funding acquisition, validation. Guarantors: SW and LW, responsible for the overall content and publication decision.

    • Funding This study was supported by the National Key Research and Development Program of China (grant No. 2022YFA1105500).

    • Disclaimer The authors declare that they have no personal financial relationships with the funding source.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.