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      Comparison of corneal dynamic parameters and tomographic measurements using Scheimpflug imaging in keratoconus

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      Journal: British Journal of Ophthalmology
      Publisher: BMJ

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          Abstract

          To compare the diagnostic ability of corneal tomography and corneal dynamic response measurements in normal and keratoconus eyes.

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          Determining in vivo biomechanical properties of the cornea with an ocular response analyzer.

          David Luce (2005)
          To study the results of an ocular response analyzer (ORA) to determine the biomechanical properties of the cornea and their relationship to intraocular pressure (IOP). Reichert Inc., Depew, New York, USA. The ORA (Reichert) makes 2 essentially instantaneous applanation measurements that permit determination of corneal and IOP effects. Measurements of several populations indicate that corneal hysteresis, a biomechanical measure, varied over a dynamic range of 1.8 to 14.6 mm Hg and was only weakly correlated with corneal thickness (r(2)=0.12); this is related to the observation that some subjects with relatively thick corneas have less-than-average corneal hysteresis. Corneal hysteresis changes diurnally, presumably as a result of hydration changes. Keratoconus, Fuchs' dystrophy, and post-LASIK patients demonstrated low corneal hysteresis. The corneal hysteresis biomechanical measure may prove valuable for qualification and predictions of outcomes of refractive surgery and in other cases in which corneal biomechanics are important.
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            Changes in collagen orientation and distribution in keratoconus corneas.

            Dawn P Gill, Sally Hayes, Stephen J. Tuft … (2005)
            To map the collagen orientation and relative distribution of collagen fibrillar mass in keratoconus corneal buttons. Structural analysis was performed by obtaining synchrotron x-ray scattering patterns across the samples at 0.25-mm intervals. The patterns were analyzed to produce two-dimensional maps of the orientation of the lamellae and of the distribution of total and preferentially aligned lamellae. Compared with normal corneas, in keratoconus the gross organization of the stromal lamellae was dramatically changed, and the collagen fibrillar mass was unevenly distributed, particularly around the presumed apex of the cone. The development of keratoconus involves a high degree of inter- and probably intralamellar displacement and slippage that leads to thinning of the central cornea and associated changes in corneal curvature. This slippage may be promoted by a loss of cohesive forces and mechanical failure in regions where lamellae bifurcate.
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              Novel pachymetric parameters based on corneal tomography for diagnosing keratoconus.

              Abhijit Sinha Roy, Fernando Luz, F Guerra … (2011)
              To describe pachymetric progression indices (PPI) of the Pentacam HR (Oculus Optikgeräte GmbH) and the concept of relational thickness, and to test their accuracy for differentiating keratoconic and normal corneas compared with single-point thickness values. One hundred thirteen individual eyes randomly selected from 113 normal patients and 44 eyes of 44 patients with keratoconus were studied using the Pentacam HR by acquiring central corneal thickness (CCT), thinnest point (TP), position of the TP and PPI at minimal (PPI Min) and maximal (PPI Max) meridians, and the average (PPI Ave) of all meridians. Relational thickness parameters were calculated as the ratios of TP and CCT and PPI values. Mann-Whitney U test assessed differences in groups for each variable. Receiver operating characteristic (ROC) curves were calculated for all variables and pairwise comparisons were performed. Statistically significant differences were noted between normal and keratoconic eyes for all parameters (P<.001), except for horizontal position of TP (P=.79). The best parameters, named Ambrósio's Relational Thickness (ART), were ART-Ave (TP/PPI Ave) and ART-Max (TP/PPI Max) with areas under the ROC curves of 0.987 and 0.983, respectively. The best cutoffs were 424 μm and 339 μm for ART-Ave and ART-Max, respectively. Pachymetric progression indices and ART had a greater area under the curve than TP and CCT (P<.001); TP (0.955) had a greater area under the curve than CCT (0.909; P=.002). Tomographic-derived pachymetric parameters were better able to differentiate normal and keratoconic corneas than single-point pachymetric measurements. Further studies are needed to evaluate the role of tomography in identifying early forms of ectasia as well as ectasia risk among LASIK candidates. Copyright 2011, SLACK Incorporated.
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                Author and article information

                Journal
                Title: British Journal of Ophthalmology
                Abbreviated Title: Br J Ophthalmol
                Publisher: BMJ
                ISSN (Print): 0007-1161
                ISSN (Electronic): 1468-2079
                Publication date Created: December 15 2017
                Publication date Created: January 2018
                Publication date (Print): January 2018
                Publication date (Electronic): May 30 2017
                Volume: 102
                Issue: 1
                Pages: 42-47
                Article
                DOI: 10.1136/bjophthalmol-2017-310355
                PubMed ID: 28559422
                SO-VID: 2eb567bc-8b62-4837-9670-d34ce95870c5
                Copyright © © 2017
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