OBEJTIVOS: Analisar a segurança e eficácia da cirurgia de crosslinking (CXL) de córnea em pacientes com ceratocone em estágios avançados após um seguimento de 4 anos. MÉTODOS: Trata-se de um estudo retrospectivo de pacientes com ceratocone avançado em progressão (Estágio 3 e 4 da classificação de Amsler-Krumeich) que foram submetidos a cirurgia de CXL seguindo o protocolo padrão. Os parâmetros examinados foram acuidade visual com (AVCC) e sem (AVSC) correção, valores ceratométricos (média, plana, curva e apical), paquimetria, e contagem de células endoteliais no préoperatório e após 12, 24 e 48 meses do procedimento. RESULTADOS: Este estudo abrange quarenta olhos de 40 pacientes que foram submetidos a cirurgia de CXL. A média de idade foi 22,5 anos (Intervalo:15 a 37 anos). Tanto a AVSC quanto a AVCC permaneceram estáveis durante o período de seguimento, sem mudanças estatisticamente significativas. Apesar de todos os valores ceratométricos sofrerem uma leve diminuição, apenas a ceratometria apical atingiu uma mudança com significado estatístico (P=0,037) após 4 anos de seguimento. Uma redução significativa da espessura corneana foi também observada (paquimetria ultrassônica era de 388 ± 49 e passou para 379 ± 48 ?m, P < 0,0001; paquimetria através de tomografia de imagem em fenda era de 362 ± 48 e foi para 353 ± 51 um, P < 0,0001); embora essa diferença não seja clinicamente significativa. A contagem de células endoteliais não sofreu alterações significativas durante o seguimento. A taxa de falha do tratamento foi de 5% (dois pacientes) durante o seguimento. CONCLUSA?O: A cirurgia de CXL corneano em pacientes com ceratocone avançado se mostrou segura e capaz de manter os parâmetros visuais e topográficos pelo menos durante 4 anos / PURPOSE: To analyze the safety and efficacy of standard corneal collagen crosslinking (CXL) in advanced cases of progressive keratoconus (KC) after four years of follow-up. METHODS: A retrospective case series of patients with advanced progressive KC (stage 3 and 4 of Amsler-Krumeich classification) underwent standard CXL treatment. The parameters examined were changes in uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), keratometry values (mean K, flattest K, steepest K, and apical K), pachymetry, and endothelial cell count at the baseline and at 12-, 24- and 48-months postoperatively. RESULTS: Forty eyes of 40 patients were enrolled into the study. The mean patient age was 22.5 years (range: 15 to 37 years). Both mean UCVA and CDVA remained stable during the time points; no statistically significant change was noted. Although a slightly reduction was observed in all keratometric readings, a statistically significant reduction was only reached in the apical K (p=0.037) at four years after CXL. A significant reduction in the pachymetry was also found (from 388±49 to 379±48 um, P < 0,0001 and from 362±48 to 353±51 um, P < 0,0001, ultrasonic and slit-scanning readings, respectively) ; however this change is not likely clinically meaningful. Endothelial cell count was not significantly modified at the end of the study. Treatment failure or progression was noted in two patients (5%) over the followup period. CONCLUSION: Standard CXL treatment seems to be safe and able to stabilize both visual acuity and topographic parameters at four-year follow-up in advanced keratoconic eyes

Objetivo: Avaliar a função visual de pacientes submetidos a transplante lamelar anterior profundo (DALK) utilizando a dissecção com tunelizador manual e fio. Métodos: Foram incluídos 33 pacientes com ceratocone que apresentavam BCVA <= 0,60 LogMar, miopia e astigmatismo entre 8,00 e 10,00D, K central médio > 53,00D, ausência de cicatrizes, espessura corneana mínima entre 300 e 400 um. Foi feita avaliação oftalmológica completa no pré e no pós-operatório de 6 a 8 meses. Estas avaliações foram complementadas com exame topográfico da córnea, microscopia especular para avaliação da densidade das células endoteliais corneanas, aberrometria corneana e exame de tomografia de coerência óptica do segmento anterior. As variáveis BCVA, UCBA e os valores totais das aberrações corneanas de alta ordem foram correlacionadas com a espessura do leito estromal residual. Resultados: Os pacientes submetidos à DALK apresentaram BCVA de 0,68 ± 0,27 LogMar o que representa BCVA superior a 20/40 em 60% da amostra analisada. Não foram observadas micro ou macroperfurações. Houve diminuição na contagem endotelial de 2702,87 ± 548,87 células por mm2 para 2282,10 ± 525,66 células por mm2 . A dissecção do estroma profundo com o fio facilitou a remoção de tecido estromal posterior, fato corroborado com o achado de que o leito residual estromal aferido foi de 49,18 ± 18,36 ?m na região central e foi inferior a 80 ?m em grande parte dos pacientes estudados. No que se refere à regularidade da dissecção, observou-se tendência a valores mais elevados de espessura residual na periferia (60,09 ± 17,70 ?m). Não houve correlação da BCVA, UCVA e do total de aberrações de alta ordem da córnea com a espessura do leito estromal residual. Conclusão: A apreciação dos resultados desse estudo mostrou que com a técnica utilizada para realização de DALK em portadores de ceratocone obteve-se resultados topográficos e funcionais semelhantes a outras técnicas consagradas pela literatura. A facilidade na dissecção do estroma profundo, a regularidade da dissecção e a presença de baixíssimo índice de conversão para transplantes penetrantes são encorajadores / Objective: Evaluate the visual function of patients undergoing deep anterior lamellar keratoplasty (DALK) using a manual spatula and a wire dissection. Methods: Thirty three keratoconus patients were included, meeting the following inclusion criteria: BCVA logMAR <=0,60, myopia and astigmatism between 8.00 and 10,00D, K central average > 53.00D, no corneal scars and minimal corneal thickness between 300 and 400 um. Complete ocular evaluation was performed preoperatively and postoperatively in 6-8 months. These assessments were supplemented by topographical survey of the cornea, specular microscopy to evaluate the density of corneal endothelial cells, corneal wavefront analysis and examination of optical coherence tomography of the anterior segment (Visante). The BCVA variables, UCVA and the total amounts of corneal higher-order aberrations were correlated with the the residual stromal bed thickness. Results: Patients that undergone to DALK with the described technique presented a BCVA of 0.68 ± 0.27 logMAR which represents a BCVA of more than 20/40 at 60% of the analyzed sample. There were no micro or macroperforations. We observed a small decrease in the endothelial cell count from 2702.87 ± 548.87 cells per mm2 to 2282.10 ± 525.66 cells per mm2. The dissection of the deep stroma with a wire facilitated the posterior stromal tissue removal, thus the measured stromal bed thickness was 49.18 ± 18.36 ?m in the central region and less than 80 ?m in the majority of the studied patients. As regards the dissection regularity, we showed a tendency to higher values of residual thickness at the periphery (60.09 ± 17.70 ?m). There was no correlation of the BCVA, UCVA and total corneal higher-order aberrations with the residual stromal bed thickness. Conclusion: The assessment of the study data showed that the described technique achieved a topographical and functional result similar to other techniques consecrated by literature. The shallow learning curve, the ease to perform the dissection of the deep stroma, the postoperative stromal regularity and the presence of very low conversion rate for penetrating keratoplasty are encouraging

OBEJTIVOS: Analisar a segurança e eficácia da cirurgia de crosslinking (CXL) de córnea em pacientes com ceratocone em estágios avançados após um seguimento de 4 anos. MÉTODOS: Trata-se de um estudo retrospectivo de pacientes com ceratocone avançado em progressão (Estágio 3 e 4 da classificação de Amsler-Krumeich) que foram submetidos a cirurgia de CXL seguindo o protocolo padrão. Os parâmetros examinados foram acuidade visual com (AVCC) e sem (AVSC) correção, valores ceratométricos (média, plana, curva e apical), paquimetria, e contagem de células endoteliais no préoperatório e após 12, 24 e 48 meses do procedimento. RESULTADOS: Este estudo abrange quarenta olhos de 40 pacientes que foram submetidos a cirurgia de CXL. A média de idade foi 22,5 anos (Intervalo:15 a 37 anos). Tanto a AVSC quanto a AVCC permaneceram estáveis durante o período de seguimento, sem mudanças estatisticamente significativas. Apesar de todos os valores ceratométricos sofrerem uma leve diminuição, apenas a ceratometria apical atingiu uma mudança com significado estatístico (P=0,037) após 4 anos de seguimento. Uma redução significativa da espessura corneana foi também observada (paquimetria ultrassônica era de 388 ± 49 e passou para 379 ± 48 ?m, P < 0,0001; paquimetria através de tomografia de imagem em fenda era de 362 ± 48 e foi para 353 ± 51 um, P < 0,0001); embora essa diferença não seja clinicamente significativa. A contagem de células endoteliais não sofreu alterações significativas durante o seguimento. A taxa de falha do tratamento foi de 5% (dois pacientes) durante o seguimento. CONCLUSA?O: A cirurgia de CXL corneano em pacientes com ceratocone avançado se mostrou segura e capaz de manter os parâmetros visuais e topográficos pelo menos durante 4 anos / PURPOSE: To analyze the safety and efficacy of standard corneal collagen crosslinking (CXL) in advanced cases of progressive keratoconus (KC) after four years of follow-up. METHODS: A retrospective case series of patients with advanced progressive KC (stage 3 and 4 of Amsler-Krumeich classification) underwent standard CXL treatment. The parameters examined were changes in uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), keratometry values (mean K, flattest K, steepest K, and apical K), pachymetry, and endothelial cell count at the baseline and at 12-, 24- and 48-months postoperatively. RESULTS: Forty eyes of 40 patients were enrolled into the study. The mean patient age was 22.5 years (range: 15 to 37 years). Both mean UCVA and CDVA remained stable during the time points; no statistically significant change was noted. Although a slightly reduction was observed in all keratometric readings, a statistically significant reduction was only reached in the apical K (p=0.037) at four years after CXL. A significant reduction in the pachymetry was also found (from 388±49 to 379±48 um, P < 0,0001 and from 362±48 to 353±51 um, P < 0,0001, ultrasonic and slit-scanning readings, respectively) ; however this change is not likely clinically meaningful. Endothelial cell count was not significantly modified at the end of the study. Treatment failure or progression was noted in two patients (5%) over the followup period. CONCLUSION: Standard CXL treatment seems to be safe and able to stabilize both visual acuity and topographic parameters at four-year follow-up in advanced keratoconic eyes

The reduction in visual performance typically found in keratoconic patients is believed to be associated with large magnitudes of uncorrected irregular astigmatism and higher-order aberrations (HOAs). Previous studies indicate that correcting HOAs in keratoconus patients may result in an improvement in visual performance. This thesis explores the correction of HOAs using standard sphero-cylindrical and customised aberration-controlling soft contact lenses in 22 patients with keratoconus. The findings of this work may be useful from a clinical perspective, as some keratoconic patients cannot tolerate rigid gas-permeable (RGP) contact lenses and have few alternatives, excluding surgical intervention, for vision correction. This thesis firstly describes a series of preliminary studies conducted to improve our current understanding of the HOAs manifested in keratoconus. The results of these investigations suggested that alterations in aberrations, due to changes in accommodation or variations in the pre-corneal tear film post-blink, were unlikely to hinder the correction of HOAs for keratoconic patients. Equally, it was ascertained that subjective refraction data provided significantly better visual acuity compared to objective, aberrometry-derived refractions for patients with keratoconus. The findings also show that both lower-order aberrations (LOAs) and HOAs displayed a larger degree of variability in keratoconic eyes compared to those previously reported for visually-normal subjects. Furthermore, significant increases in 3rd-order coma root mean square aberrations were found after temporarily suspending RGP contact lens wear for 16 keratoconic patients. The results of two clinical studies suggested that standard sphero-cylindrical soft lenses can, to some extent, mask HOAs in keratoconic patients; however, the visual performances achieved were found to be poorer compared to RGP lenses. Equally, the results showed that RGP lenses provide superior visual performances compared to customised, aberration-controlling lenses, in spite of the customised lenses providing comparable reductions in uncorrected HOAs. The inducement of superfluous HOAs and LOAs, through customised contact lens translations and rotations, were modelled using MatLab (version 7.6.0.324; The Mathworks, Natick, MA, US). The results confirmed that minimising the decentration of aberration-controlling contact lenses, to less than 5 degrees of rotation and less than 0.50 mm of translation, will help to achieve an optimal correction of HOAs. However, more stringent criteria were required for LOAs, where rotational displacements should be reduced to less than 3 degrees and translational displacements should be limited to less than 0.10 mm. In conclusion, the correction of HOAs for patients with keratoconus is possible using customised, aberration-controlling soft contact lenses; however, several factors will govern their success, including the repeatability and accuracy of HOA measurements for these irregular corneas, and the stability of the customised lenses on-eye.

Objetivo: Avaliar a função visual de pacientes submetidos a transplante lamelar anterior profundo (DALK) utilizando a dissecção com tunelizador manual e fio. Métodos: Foram incluídos 33 pacientes com ceratocone que apresentavam BCVA <= 0,60 LogMar, miopia e astigmatismo entre 8,00 e 10,00D, K central médio > 53,00D, ausência de cicatrizes, espessura corneana mínima entre 300 e 400 um. Foi feita avaliação oftalmológica completa no pré e no pós-operatório de 6 a 8 meses. Estas avaliações foram complementadas com exame topográfico da córnea, microscopia especular para avaliação da densidade das células endoteliais corneanas, aberrometria corneana e exame de tomografia de coerência óptica do segmento anterior. As variáveis BCVA, UCBA e os valores totais das aberrações corneanas de alta ordem foram correlacionadas com a espessura do leito estromal residual. Resultados: Os pacientes submetidos à DALK apresentaram BCVA de 0,68 ± 0,27 LogMar o que representa BCVA superior a 20/40 em 60% da amostra analisada. Não foram observadas micro ou macroperfurações. Houve diminuição na contagem endotelial de 2702,87 ± 548,87 células por mm2 para 2282,10 ± 525,66 células por mm2 . A dissecção do estroma profundo com o fio facilitou a remoção de tecido estromal posterior, fato corroborado com o achado de que o leito residual estromal aferido foi de 49,18 ± 18,36 ?m na região central e foi inferior a 80 ?m em grande parte dos pacientes estudados. No que se refere à regularidade da dissecção, observou-se tendência a valores mais elevados de espessura residual na periferia (60,09 ± 17,70 ?m). Não houve correlação da BCVA, UCVA e do total de aberrações de alta ordem da córnea com a espessura do leito estromal residual. Conclusão: A apreciação dos resultados desse estudo mostrou que com a técnica utilizada para realização de DALK em portadores de ceratocone obteve-se resultados topográficos e funcionais semelhantes a outras técnicas consagradas pela literatura. A facilidade na dissecção do estroma profundo, a regularidade da dissecção e a presença de baixíssimo índice de conversão para transplantes penetrantes são encorajadores / Objective: Evaluate the visual function of patients undergoing deep anterior lamellar keratoplasty (DALK) using a manual spatula and a wire dissection. Methods: Thirty three keratoconus patients were included, meeting the following inclusion criteria: BCVA logMAR <=0,60, myopia and astigmatism between 8.00 and 10,00D, K central average > 53.00D, no corneal scars and minimal corneal thickness between 300 and 400 um. Complete ocular evaluation was performed preoperatively and postoperatively in 6-8 months. These assessments were supplemented by topographical survey of the cornea, specular microscopy to evaluate the density of corneal endothelial cells, corneal wavefront analysis and examination of optical coherence tomography of the anterior segment (Visante). The BCVA variables, UCVA and the total amounts of corneal higher-order aberrations were correlated with the the residual stromal bed thickness. Results: Patients that undergone to DALK with the described technique presented a BCVA of 0.68 ± 0.27 logMAR which represents a BCVA of more than 20/40 at 60% of the analyzed sample. There were no micro or macroperforations. We observed a small decrease in the endothelial cell count from 2702.87 ± 548.87 cells per mm2 to 2282.10 ± 525.66 cells per mm2. The dissection of the deep stroma with a wire facilitated the posterior stromal tissue removal, thus the measured stromal bed thickness was 49.18 ± 18.36 ?m in the central region and less than 80 ?m in the majority of the studied patients. As regards the dissection regularity, we showed a tendency to higher values of residual thickness at the periphery (60.09 ± 17.70 ?m). There was no correlation of the BCVA, UCVA and total corneal higher-order aberrations with the residual stromal bed thickness. Conclusion: The assessment of the study data showed that the described technique achieved a topographical and functional result similar to other techniques consecrated by literature. The shallow learning curve, the ease to perform the dissection of the deep stroma, the postoperative stromal regularity and the presence of very low conversion rate for penetrating keratoplasty are encouraging

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-03T15:39:07Z No. of bitstreams: 2 Tese - Francisco Weliton Rodrigues - 2016.pdf: 2820619 bytes, checksum: af037c3015b0edc5e8691d768f2d6194 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-03T15:39:26Z (GMT) No. of bitstreams: 2 Tese - Francisco Weliton Rodrigues - 2016.pdf: 2820619 bytes, checksum: af037c3015b0edc5e8691d768f2d6194 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-04-03T15:39:26Z (GMT). No. of bitstreams: 2 Tese - Francisco Weliton Rodrigues - 2016.pdf: 2820619 bytes, checksum: af037c3015b0edc5e8691d768f2d6194 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-07-19 / Keratoconus is a chronic non-inflammatory ocular disorder characterized by central thinning, protrusion and conical shape of the cornea. The progression of this disorder cause a significant decrease in visual acuity. It has been suggested that the development of keratoconus has a genetic component. Therefore, the aim of this study was to evaluate the frequency of single nucleotide polymorphisms (SNP) mutations associated with keratoconus in unrelated Brazilian patients compared to healthy subjects. This was a case-control clinical study with 108 participants, 46 patients with keratoconus and 62 healthy subjects (controls). Peripheral blood, collected from all participants, was used to extract DNA samples. Subsequently, genotyping of three single nucleotide polymorphisms, TGFBI rs4669 and rs2072239 and VSX1 rs6138482, was performed through real-time polymerase chain reactions (qPCR). Single nucleotide polymorphisms were observed in both keratoconus patients and healthy subjects. For the VSX1 gene, allelic frequency and discrimination was similar for keratoconus patients and controls. Conversely, the frequency of the mutant allele was significantly higher for two SNPs on the TGFBI gene in patients with keratoconus. For the SNP rs4669, the patients with keratoconus had 15 % higher frequency of the mutated allele, while for the SNP rs2072239 the patients had 11 % higher frequency of the mutated allele compared to the controls. Individuals carrying the mutant allele had two-times more risk in developing the disease. The allelic discrimination of genotypes (homozygous and heterozygous) was also significantly different for both SNPs on the TGFBI gene. This study has demonstrated, for the first time, an association of SNP mutations and the development of keratoconus in Brazilian patients. The frequency of the mutant and potentially pathogenic allele on the TGFBI gene was significantly higher in patients compared to controls. Finally, these findings contribute to the advance of molecular knowledge of the pathogenesis, development of early diagnostic tools and therapeutics options for patients with keratoconus. / O ceratocone é uma desordem ocular caracterizada pelo afinamento central, protrusão e formato cônico da córnea. A progressão desta desordem causa diminuição significativa da acuidade visual. Existem evidências de que o ceratocone apresenta componente genético. Assim, o objetivo desse estudo foi avaliar a frequência de mutações de polimorfismo de nucleotídeo único (SNP) associados a ocorrência do ceratocone em pacientes brasileiros sem parentesco conehcido em comparação à voluntários saudáveis. Este foi um estudo clínico do tipo caso-controle com um total de 108 participantes, 46 pacientes com ceratocone e 62 voluntários saudáveis (controles). Amostras de sangue periférico foram coletadas e utilizadas para extração do DNA. Subsequentemente, o genótipo de três polimorfismos de nucleotídeo único, TGFBI rs4669 e rs2072239 e VSX1 rs6138482, foram determinados através de reações em cadeia polimerizada em tempo real (qPCR). Polimorfismos de nucleotídeo único foram observados em ambos os pacientes e controles. Para o gene VSX1 (SNP rs6138482) a frequência e discriminação alélica não houve diferenças estatisticamente significantes (p<0,005) em pacientes e controles. No entanto, para o gene TGFBI, existiram diferenças significativas em relação a frequência e discriminação alélica. Para o SNP rs4669 a frequência do alelo mutante foi 15 % maior e para o SNP rs2072239 uma frequência 11 % maior em pacientes com ceratocone comparado aos controles. Além disso, os indivíduos que apresentaram o alelo mutante têm um risco (razão de probabilidade) duas vezes maior de desenvolver a doença. Este estudo demostrou, pela primeira vez, que existe uma associação entre dois SNP e o desenvolvimento do ceratocone em pacientes brasileiros. A frequência do alelo mutante e potencialmente patogênico no gene TGFBI foi significativamente maior pacientes comparado aos controles. Concluindo, os resultados deste estudo contribuem para o conhecimento molecular da patogênese, o desenvolvimento de técnicas de diagnóstico precoce e consequentemente mais opções de tratamento para pacientes com ceratocone.

The aim of this project was to analyse the cellular and biomechanical changes after collagen cross-linking (CXL) treatment on postmortem eye-banked human corneas using different UVA intensities and repeated treatments, and to explore the effects of standard collagen cross-linking on keratoconic corneal buttons, in-vitro. Preliminary studies were conducted to assess the feasibility of using eye-banked corneas to assess the effects of collagen cross-linking, and the possibility of applying scanning acoustic microscopy (SAM) to measure the speed of sound/elasticity of corneal tissue. Eye-banked human corneas were successfully cross-linked allowing the effects of CXL to be studied in-vitro and SAM was used effectively to determine the mechanical properties of corneal tissue at different depths. The results of two experiments comparing UVA intensity suggested that no statistically significant difference was found in the histological changes or in the induced stiffness after applying low and high intensity cross-linking on normal human corneas. However, the number of apoptotic cells was found to be significantly less but deeper into the posterior stroma in the high intensity cross-linked corneas. Collectively, these results confirmed the safety and efficacy of both techniques with the advantage of reducing the treatment time using the higher-intensity treatment. In another in-vitro study, keratoconic corneal tissue was used. Different histological and biomechanical outcomes were found between the cross-linked and control keratoconic tissue. The effects of cross-linking were found to penetrate deeper in the keratoconic tissue compared to in the normal corneal tissue found in previous studies. This could be due to the altered collagens and extracellular matrix of the keratoconic corneas, as they were taken from patients in advanced stages of the disease. This study confirmed the importance of having corneal thickness of at least 400μm after epithelial debriding to maintain the endothelial cell density and integrity. Finally, further cross-links were induced when collagen cross-linking treatment was repeated. However, repeating cross-linking three times a deeper cell death close to the endothelium was noticed which suggests that multiple treatments could be unsafe. Additionally, lower speed of sound than the cross-linking twice. This could be due to elimination of the induced cross-links by longer exposure to UVA irradiation. In conclusion, eye-banked human corneas were successfully used to evaluate the effects of cross-linking treatment and repeated treatment. Additionally, keratoconic corneal buttons were used to study the effects of collagen cross-linking in-vitro. This model of using eye-banked human corneas and keratoconic corneal tissue enabled us to study the effects of cross-linking treatment using different protocols and the effects of repeated treatment, and it could ultimately be used to compare the results with in-vivo studies.

No description available.

No description available.

Yes / Background: This study proposes a decision support system created in collaboration with machine learning experts and ophthalmologists for detecting keratoconus (KC) severity. The system employs an ensemble machine model and minimal corneal measurements. Methods: A clinical dataset is initially obtained from Pentacam corneal tomography imaging devices, which undergoes pre-processing and addresses imbalanced sampling through the application of an oversampling technique for minority classes. Subsequently, a combination of statistical methods, visual analysis, and expert input is employed to identify Pentacam indices most correlated with severity class labels. These selected features are then utilized to develop and validate three distinct machine learning models. The model exhibiting the most effective classification performance is integrated into a real-world web-based application and deployed on a web application server. This deployment facilitates evaluation of the proposed system, incorporating new data and considering relevant human factors related to the user experience. Results: The performance of the developed system is experimentally evaluated, and the results revealed an overall accuracy of 98.62%, precision of 98.70%, recall of 98.62%, F1-score of 98.66%, and F2-score of 98.64%. The application's deployment also demonstrated precise and smooth end-to-end functionality. Conclusion: The developed decision support system establishes a robust basis for subsequent assessment by ophthalmologists before potential deployment as a screening tool for keratoconus severity detection in a clinical setting.