Neuroendoscopic access to the third ventricle in patients with narrow foramen of monro without stenosis/obstruction: role of foraminoplasty.

OBJECT: One of the critical steps for the success of intraventricular neuroendoscopic procedures is the entry into the third ventricle and passage of the endoscopy system through the foramen of Monro (FM). A diameter larger than that of the instrument used is considered a prerequisite for safely performing the technique, as damage to this structure can lead to alterations in the fornix and vascular structures. When the foramen diameter is narrow and there is no obstruction/stenosis, the role of foraminoplasty in reducing the risk of complications has not been adequately assessed in the literature. METHODS: A review of endoscopic procedures conducted at our center since 2018 was undertaken. Cases in which preoperative imaging indicated a FM diameter < 6 mm and foraminoplasty technique was applied were examined to determine the technical and functional success of the procedure. The technical success was determined by completing the neuroendoscopic procedure with the absence of macroscopic lesions in the various structures comprising the foramen and without complications in the follow-up imaging tests. Functional success was defined as the absence of cognitive/memory alterations during the 3-month postoperative follow-up. Additionally, a review of the various forms of foraminoplasty described in the literature is conducted. RESULTS: In our cohort, six patients were identified with a preoperative FM diameter < 6 mm without obstruction or stenosis. Foraminoplasty was planned for these cases to facilitate various intraventricular neuroendoscopic procedures. In all instances, the technique was successfully performed without causing macroscopic damage to the structures comprising the foramen. Follow-up visits included various cognitive tests to assess potential sequelae related to microscopic damage to the fornix. None of the patients exhibited anomalies. CONCLUSION: Foraminoplasty in patients with a narrow FM without signs of stenosis/obstruction is a useful technique to reduce the risk of complications during the passage of the endoscopy system through this structure, enabling the safe performance of neuroendoscopic procedures.

Robust keratoconus detection with Bayesian network classifier for Placido-based corneal indices.

PURPOSE: To evaluate in a sample of normal and keratoconic eyes a simple Bayesian network classifier for keratoconus identification that uses previously developed topographic indices, calculated directly from the digital analysis of the Placido ring images. METHODS: A comparative study was performed on a total of 60 eyes from 60 patients (age 20-60 years) from the Department of keratoconus of INVISION Ophthalmology clinic (Almería, Spain). Patients were divided into two groups depending on their preliminary diagnosis based on the classical topographic criteria: a control group without topographic alteration (30 eyes) and a keratoconus group (30 eyes). The keratoconus group included all grades except grade IV with excessively distorted corneal topography. All cases were examined using the CSO topography system (CSO, Firenze, Italy), and primary corneal Placido-indices were computed, as described in literature. Finally, a classifier was built by fitting a conditional linear Gaussian Bayesian network to the data, using the 5- and 10-fold cross-validation. For comparison, the original data were perturbed with random white noise of different magnitude. RESULTS: The naïve Bayes classifier showed perfect discrimination ability among normal and keratoconic corneas, with 100% of sensibility and specificity, even in the presence of a very significant noise. CONCLUSIONS: The Bayesian network classifiers are highly accurate and proved a stable screening method to assist ophthalmologists with the detection of keratoconus, even in the presence of noise or incomplete data. This algorithm is easily implemented for any Placido topographic system.

Screening subclinical keratoconus with placido-based corneal indices.

PURPOSE: To assess in a sample of normal, keratoconic, and keratoconus (KC) suspect eyes the performance of a set of new topographic indices computed directly from the digitized images of the Placido rings. METHODS: This comparative study was composed of a total of 124 eyes of 106 patients from the ophthalmic clinics Vissum Alicante and Vissum Almería (Spain) divided into three groups: control group (50 eyes), KC group (50 eyes), and KC suspect group (24 eyes). In all cases, a comprehensive examination was performed, including the corneal topography with a Placido-based CSO topography system. Clinical outcomes were compared among groups, along with the discriminating performance of the proposed irregularity indices. RESULTS: Significant differences at level 0.05 were found on the values of the indices among groups by means of Mann-Whitney-Wilcoxon nonparametric test and Fisher exact test. Additional statistical methods, such as receiver operating characteristic analysis and K-fold cross validation, confirmed the capability of the indices to discriminate between the three groups. CONCLUSIONS: Direct analysis of the digitized images of the Placido mires projected on the cornea is a valid and effective tool for detection of corneal irregularities. Although based only on the data from the anterior surface of the cornea, the new indices performed well even when applied to the KC suspect eyes. They have the advantage of simplicity of calculation combined with high sensitivity in corneal irregularity detection and thus can be used as supplementary criteria for diagnosing and grading KC that can be added to the current keratometric classifications.

Placido-based indices of corneal irregularity.

PURPOSE: To construct a set of indices that measure the irregularity of the anterior corneal surface, computed directly from the image of the Placido disks reflected on the cornea. Besides the high sensitivity and specificity, this approach allows bypassing the surface or curvature reconstruction step that is currently performed by the software of any commercial Placido topographer. METHODS: Several basic indices are proposed to detect irregularities on the anterior surface of the cornea, via analyzing some geometric and mathematical properties of the mires. These individual primary indices are built directly from the displacement of the digitized images of the rings reflected on the cornea. In addition, compound metrics are proposed (such as the generalized linear model or the classification trees) by combining some of the primary indices to improve their efficiency. The computed metrics were developed and tested for the CSO topography system (CSO, Firenze, Italy), but the methodology proposed here extends easily to any other commercial Placido disks topographer. RESULTS: The primary indices allow discriminating, with excellent accuracy, between normal eyes and eyes with keratoconic corneas. Sensitivity and specificity of the primary indices is analyzed by using the receiver operating characteristic (ROC) curve methodology. Some combined indices are presented, which raise the efficiency to optimal. CONCLUSIONS: All the primary indices proposed in this work exhibit very good performance in discriminating between normal and irregular corneas. The accuracy of the combined indices is optimal within the test group (perfect classification), allowing their use in clinical practice as corneal markers of a disease. All these indices are fast to compute and can be easily implemented in any corneal topography system.