Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 24;44(5):539-549.
doi: 10.1097/ICO.0000000000003641.

Interpretable Machine Learning-Based Risk Score for Predicting 10-Year Corneal Graft Survival After Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty in Asian Eyes

Clarissa Ng Yin Ling  1 , Feng He  2 , Stephanie Lang  1 , Charumathi Sabanayagam  2   3 , Ching-Yu Cheng  2   3 , Anshu Arundhati  1   2   3 , Jodhbir S Mehta  1   2   3 , Marcus Ang  1   2   3
Affiliations

Interpretable Machine Learning-Based Risk Score for Predicting 10-Year Corneal Graft Survival After Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty in Asian Eyes

Clarissa Ng Yin Ling et al. Cornea. .

Abstract

Purpose: To predict 10-year graft survival after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) using a machine learning (ML)-based interpretable risk score.

Methods: Singapore Corneal Transplant Registry patients (n = 1687) who underwent DALK (n = 524) or PK (n = 1163) for optical indications (excluding endothelial diseases) were followed up for 10 years. Variable importance scores from random survival forests were used to identify variables associated with graft survival. Parsimonious analysis using nested Cox models selected the top factors. An ML-based clinical score generator (AutoScore) converted identified variables into an interpretable risk score. Predictive performance was evaluated using Kaplan-Meier (KM) curves and time-integrated AUC (iAUC) on an independent testing set.

Results: Mean recipient age was 51.8 years, 54.1% were male, and majority were Chinese (60.0%). Surgical indications included corneal scar (46.5%), keratoconus (18.3%), and regraft (16.2%). Five-year and ten-year KM survival was 93.4% and 92.3% for DALK, compared with 67.6% and 56.6% for PK (log-rank P < 0.001). Five factors were identified by ML algorithm as predictors of 10-year graft survival: recipient sex, preoperative visual acuity, choice of procedure, surgical indication, and active inflammation. AutoScore stratified participants into low-risk and high-risk groups-with KM survival of 73.6% and 39.0%, respectively (log-rank P < 0.001). ML analysis outperformed traditional Cox regression in predicting graft survival beyond 5 years (iAUC 0.75 vs. 0.69).

Conclusions: A combination of ML and traditional techniques identified factors associated with graft failure to derive a clinically interpretable risk score to stratify PK and DALK patients-a technique that may be replicated in other corneal transplant programs.

PubMed Disclaimer

Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

References

    1. Ang M, Mohamed-Noriega K, Mehta JS, et al. Deep anterior lamellar keratoplasty: surgical techniques, challenges, and management of intraoperative complications. Int Ophthalmol Clin. 2013;53:47–58.
    1. Gain P, Jullienne R, He Z, et al. Global survey of corneal transplantation and eye banking. JAMA Ophthalmol. 2016;134:167–173.
    1. Tan DTH, Janardhanan P, Zhou H, et al. Penetrating keratoplasty in Asian eyes: the singapore corneal transplant study. Ophthalmology. 2008;115:975–982.e1.
    1. Ong HS, Ang M, Mehta J. Evolution of therapies for the corneal endothelium: past, present and future approaches. Br J Ophthalmol. 2021;105:454–467.
    1. Tan DT, Dart JK, Holland EJ, et al. Corneal transplantation. Lancet. 2012;379:1749–1761.

LinkOut - more resources