Application of the Monte Carlo Method for the Assessment of Long-term Success in Keratoprosthesis Surgery

The comparison of different methods of keratoprosthesis (KP) regarding their long-term success, as far as visual acuity is concerned, is difficult: this is the case both as a standardized reporting method agreed upon by all research groups has not been reported and far less accepted, and as the quality of life for the patient not only depends on the level of visual acuity, but also quite significantly on the “survival time” of the implant. Therefore, an analysis of a single series of patients with Osteo–Odonto–Keratoprosthesis (OOKP) was performed. Statistical analysis methods used by others in similar groups of surgical procedures have included descriptive statistics, survival analysis and ANOVA. These methods comprised comparisons of empirical densities or distribution functions and empirical survival curves. It is the objective of this paper to provide an inductive statistical method to avoid the problems with descriptive techniques and survival analysis. This statistical model meets four important standards: (1) the efficiency of a surgical technique can be assessed within an arbitrary time interval by a new index (VAT-index), (2) possible autocorrelations of the data are taken into consideration and (3) the efficiency is not only stated by a point estimator, but also 95% point-wise confidence limits are computed based on the Monte Carlo method, and finally, (4) the efficiency of a specific method is illustrated by line and range plots for quick illustration and can also be used for the comparison of different other surgical techniques such as refractive techniques, glaucoma and retinal surgery.