An Explainable AI Framework for Corneal Imaging Interpretation and Refractive Surgery Decision Support.

This study introduces an explainable neuro-symbolic and large language model (LLM)-driven framework for intelligent interpretation of corneal topography and precision surgical decision support. In a prospective cohort of 20 eyes, comprehensive IOLMaster 700 reports were analyzed through a four-stage pipeline: (1) automated extraction of key parameters-including corneal curvature, pachymetry, and axial biometry; (2) mapping of these quantitative features onto a curated corneal disease and refractive-surgery knowledge graph; (3) Bayesian probabilistic inference to evaluate early keratoconus and surgical eligibility; and (4) explainable multi-model LLM reporting, employing DeepSeek and GPT-4.0, to generate bilingual physician- and patient-facing narratives. By transforming complex imaging data into transparent reasoning chains, the pipeline delivered case-level outputs within ~95 ± 12 s. When benchmarked against independent evaluations by two senior corneal specialists, the framework achieved 92 ± 4% sensitivity, 94 ± 5% specificity, 93 ± 4% accuracy, and an AUC of 0.95 ± 0.03 for early keratoconus detection, alongside an F1 score of 0.90 ± 0.04 for refractive surgery eligibility. The generated bilingual reports were rated ≥4.8/5 for logical clarity, clinical usefulness, and comprehensibility, with representative cases fully concordant with expert judgment. Comparative benchmarking against baseline CNN and ViT models demonstrated superior diagnostic accuracy (AUC = 0.95 ± 0.03 vs. 0.88 and 0.90,