Abstract
<jats:p>Purpose. To analyze the clinical and functional outcomes of the first stage of keratoprosthesis implantation in patients with vascular corneal leucoma and to determine the optimal method for intralamellar plate implantation depending on the leucoma thickness. Material and methods. This study enrolled 83 patients (83 eyes) with burn injuries and terminal dystrophic corneal opacities who underwent the surgical treatment. The average age of the patients was 53.6±16.6 years (from 19 to 86 years), of whom 64 were men and 19 were women. All patients underwent the first stage of keratoprosthesis implantation. It involved the implantation of the intralamellar plate into the intrastromal pocket formed either manually or using the femtosecond laser. Some patients underwent temporal fascia autograft covering simultaneous with the first stage of keratoprosthesis implantation to reduce the risk of intralamellar plate protrusion. There were used three keratoprosthesis models: standard Fyodorov – Zuev keratoprosthesis, its modification and the new model manufactured by Reper NN. Results. The algorithm for the surgical treatment of these patients was developed based on the decision tree for predicting the outcome of the keratoprosthesis implantation. It states: if leucoma thickness is more than 745.5 μm, the standard Fyodorov – Zuev keratoprosthesis implantation is possible; if leucoma thickness varies from 553.5 to 745.5 μm or is more than 745.5 μm, modified Fyodorov – Zuev or Reper-NN keratoprosthesis implantation is possible; if leucoma thickness is less than 553.5 μm, it is recommended to perform corneal-prosthetic complex transplantation. Conclusion. Based on the analysis of the clinical and functional characteristics of the first stage of keratoprosthesis in patients with vascular corneal scars, a machine learning model «Decision Tree» (ROC AUC=0.80±0.08) was developed, and it was determined that the greatest impact on the outcome of keratoprosthesis is exerted by the thickness of the vascular scar before surgery, as well as the keratoprosthesis model. The developed surgical treatment algorithm can determine the optimal method for implanting the support plate depending on the pachymetric characteristics of the scar and help significantly reduce the risk of complications. Keywords: keratoprosthesis, intralamellar plate, corneal leucoma.</jats:p>