Purpose Cornea guttata (CG) prevalence post keratoplasty varies from 15 to 18%, with 1 to 2% of the cases presenting with significant negative outcomes. The purpose of this research project is to create a program based on artificial intelligence (AI) that helps with the detection of CG in the donor corneas (DC) in the eye bank.
Methods Preoperative corneal endothelial images (PCEI) of patients who underwent keratoplasty were collected and classified into 2 groups according to the postoperative CG grade. Group 1 included healthy corneas and those having mild postoperative CG, while group 2 included corneas with severe postoperative CG. Using previously tested semi-quantitative morphological criteria along with other characteristics such as donor age and lens status, the PCEI were analyzed and used to create and train an AI-based tool for the detection of CG. The underlying concept of the tool compares previous cases with comparable properties to the DC in test. The postoperative CG grades of previous cases similar to the DC in test determine the prediction for its CG grade. Finally, the features and CG grade of the analyzed DC are stored in the database for future use.
Results In total, 6221 PCEI belonging to 1078 patients were used to create a transparent and explainable decision support tool for the detection of CG through a hybrid approach combining 2 components. (1) Graphical analytic tools, whereby the PCEI pass multiple OpenCV-based image processing steps including the Watershed transform algorithm. In this step, cell membranes are delineated, and abnormally large cells or cell depleted areas are marked in red. Several other cell representations such as ‘honeycomb’ representation are created for an enhanced visualization of the endothelial layer (EL). (2) Machine learning (ML) classifiers including Case-Based Reasoning were created to detect CG. Initial experiments showed a performance comparable to humans (4-fold evaluation yielded precision: weighted F1 score:0.93).
Conclusion We presented an AI-based program able to facilitate the detection of CG in the DC in the eye bank by comparing the PCEIs with relevant previous cases, using ML classifiers and offering an enhanced visualization of the EL. The evaluation and optimization of this program will follow as the next stage of our project.
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