Outcomes Of Minimally Invasive Unilateral Recession-Resection Surgery And Establishment Of An Artificial Intelligence Operation Dosage Design System

PURPOSE:To observe the outcomes after minimally invasive unilateral recession-resection(R&R)surgery and to establish an artificial intelligence(AI)-based operation dosage design system for modified strabismus surgery.DESIGN:Retrospective,cross-sectional study.METHODS:Basic and fusional convergence insufficient intermittent exotropia(IXT)patients with an exodeviation angle between 20 and 85 prism diopters underwent the minimally invasive R&R surgery.The core procedure of the operation is to separate and completely resect the check ligaments.After at least six months of follow-up,the exodeviation angle,postoperative success rate,pre-and postoperative fusional function and change in stereopsis were observed retrospectively.The predictive model was established based on the successful cases;52 related factors were entered into the model.The machine learning algorithm LightGBM was used to train the model.RESULTS:In all,113 patients were included:48 males(8.19±3.29 years old)and 65 females(8.18±3.01 years old).The average follow-up time was 0.749 years.After the last follow-up,there were 97 patients(+4PD～-8PD)with satisfactory outcome,3 patients with postoperative overcorrection(+6PD～+8PD),and 13 patients with undercorrection(-10PD～20PD).The surgical success,overcorrection and undercorrection rates were 85.8%(97/113),2.7%(3/113)and 11.5%(13/113),respectively.Near stereoacuity:77 patients(68.1%)had a near stereoacuity value of 40" in the last follow-up.10 patients who had no near stereoacuity before surgery obtained the function after surgery,and the Titmus values can be maintained in the range of 40 radians to 200 radians.In the last observation,60.18%(n=68)of the patients’near-stereoscopic vision has been significantly improved compared with the previous ones.The preoperative range is 40"～800",the rear range is 40"～400".For distance stereoacuity,85(75.22%)patients showed recovery,47 patients who had no distance stereoacuity before surgery developed this function postoperatively,ranges from 60" to 800".There is no significant difference regarding the presence or absence of stereoacuity(chi-square test,χ2=3.762,P>0.05).The AI-based operation design predictive model was preliminarily established;the accuracy reached 95%.CONCLUSION:Minimally invasive unilateral R&R surgery is effective for treating basic and convergence insufficient IXT,with a high postoperative success rate and good binocular functional recovery.This could be a standard surgical design for treating basic and convergence insufficient IXT.An AI surgery dosage design system was initially established.