Optical projection mires for measurements of the radii of curvature of the cornea in biomicroscopes

Keratometry device for surgical support

Background

High astigmatisms are usually induced during corneal suturing subsequent to tissue transplantation or any other surgery which involves corneal suturing. One of the reasons is that the procedure is intimately dependent on the surgeon's skill for suturing identical stitches. In order to evaluate the influence of the irregularity on suturing for the residual astigmatism, a prototype for ophthalmic surgical support has been developed. The final intention of this prototype is to be an evaluation tool for guided suture and as an outcome diminish the postoperative astigmatism.

Methods

The system consists of hand held ring with 36 infrared LEDs, that is to be projected onto the lachrymal film of the cornea. The image is reflected back through the optics of the ocular microscope and its distortion from the original circular shape is evaluated by developed software. It provides keratometric and circularity measurements during surgery in order to guide the surgeon for uniformity in suturing.

Results

The system is able to provide up to 23D of astigmatism (32D - 55D range) and is ± 0.25D accurate. It has been tested in 14 volunteer patients intraoperative and has been compared to a commercial keratometer Nidek Oculus Hand-held corneal topographer. The correlation factors are 0.92 for the astigmatism and 0.97 for the associated axis.

Conclusion

The system is potentially efficient for guiding the surgeon on uniformity of suturing, presenting preliminary data indicating an important decrease on the residual astigmatism, from an average of 8D - for patients not submitted to the prototype guidance - to 1.4D - for patients who have actually been submitted to the prototype guidance - after the first 24 hours post-surgery and in the subsequent weeks. It also indicates that the surgeon should achieve circularity greater or equal to 98% in order to avoid postoperative astigmatisms over 1D.

Trial Registration

Trial registration number: CAAE - 0212.0.004.000-09.

Damped least-squares approach for point-source corneal topography

An optimization algorithm to be used in point-source corneal topographers is developed for the reconstruction of the topography of aspheric corneal surfaces. It is based on the damped least-squares technique. The reconstructions obtained with a topographer comprising 48 or 90 point sources for corneas having different forms (spherical, conicoidal, complex) and apical radii (5-16 mm) were simulated numerically. Zernike polynomials up to the seventh radial order were used for the description of the shape of the anterior corneal surface. With no noise, i.e. uncertainty in the position of the image of each object point, it is shown that this approach allows reconstruction of the surface with a root-mean-square (RMS) error of <5 x 10(-7) microm for the elevation map and 3 x 10(-7) diopter for the refraction map. With noise, to get an averaged surface elevation RMS error of <1 microm, or an averaged refraction RMS error of <0.25 diopter, each spot must be located (in the image plane) with an error <1 microm.