Topographic Keratoconus Incidence in Greece Diagnosed in Routine Consecutive Cataract Procedures: A Consecutive Case Series of 1250 Cases over 5 Years
Abstract
:1. Introduction
2. Methods
- astigmatism image truncation;
- and/or astigmatic irregularity as asymmetry between the two ends of the “bowtie”;
- and/or “scissoring” of the astigmatism “bowtie”.
- cornea pachymetry “step’ changes in ellipsoid instead of circular shape, which are usually “skewed” infero-temporally;
- more than two to three thickness “steps”; multiple steps (instead of the usual two or three) are unusual even in corneas with high cylindrical power.
- Group A: the keratoconus cases, classified as such by the Pentacam;
- Group B: suspicious for keratoconus based on the criteria noted above;
- Group C: “normal” corneas for keratoconus both by the Pentacam and by the expert review;
- Group D: irregular corneas not keratoconus-related and not noted in the patient’s documented respective ophthalmic history. The evaluation by these experienced clinicians was necessary to classify the Scheimpflug tomographic imaging, excluding those cases already defined by the device as keratoconus, into one of the other three different categories:
3. Results
- A: A total of 138, or 11.04%, were included in group A by default, as they were found to be already classified by Pentacam analysis as keratoconus stages 1–3.
- B: A total of 314, or 25.12%, were in group B, with suspected keratoconus or forme fruste keratoconus (as first introduced by Amsler).
- C: A total of 725, or 58%, were placed in group C as they were found to have normal corneal parameters upon Scheimpflug tomography.
- D: A total of 73, or 5.84%, were placed in group D, as they had non-normal features but no keratoconus.
4. Discussion
- With regard to corneal tomography, the IHD (index of height decentration) seems to be the most sensitive parameter for documenting corneal regularity or change and the evolving irregularity that corneal ectasia typically manifests. The second is the ISV (index of surface variance), according to the extensive correlation of the studied keratoconus cases as well as the topometric asymmetry indices, provided by the Pentacam. The third is the IHA (index of height asymmetry) [33,34]. All are far more sensitive than visual acuity, a facet of visual function and metric that usually brings a corneal ectasia patient to ophthalmic care. Ironically, in our study, visual acuity was a very poor predictive and diagnostic factor for keratoconus, meaning many clinicians should be cautioned against using it as a corneal imaging methodology and a broad screening method for the diagnosis of keratoconus in the general population. These anterior corneal curvature asymmetry indices are provided by the topometric data analysis that the Pentacam device itself can provide.
- Also referenced in the study is our extensive reported work in evaluating corneal epithelial mapping changes, both with high-frequency ultrasound and anterior segment OCT, as an early sign of ectasia development and its respective clinical importance in early diagnosis. This parameter was not used in this study as we did not have pre-cataract surgery images of the cornea and epithelia of all patients that we retrospectively analyzed [33,35].
- Lastly, we have also reported a suggested algorithm using anterior segment OCT, derived corneal thickness, asymmetry measurements as an early sign of keratoconus diagnosis, and even the suspicion of keratoconus [35].
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Kanellopoulos, A.J.; Kanellopoulos, A.J. Topographic Keratoconus Incidence in Greece Diagnosed in Routine Consecutive Cataract Procedures: A Consecutive Case Series of 1250 Cases over 5 Years. J. Clin. Med. 2024, 13, 2378. https://doi.org/10.3390/jcm13082378
Kanellopoulos AJ, Kanellopoulos AJ. Topographic Keratoconus Incidence in Greece Diagnosed in Routine Consecutive Cataract Procedures: A Consecutive Case Series of 1250 Cases over 5 Years. Journal of Clinical Medicine. 2024; 13(8):2378. https://doi.org/10.3390/jcm13082378
Chicago/Turabian StyleKanellopoulos, Anastasios John, and Alexander J. Kanellopoulos. 2024. "Topographic Keratoconus Incidence in Greece Diagnosed in Routine Consecutive Cataract Procedures: A Consecutive Case Series of 1250 Cases over 5 Years" Journal of Clinical Medicine 13, no. 8: 2378. https://doi.org/10.3390/jcm13082378