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      Increased Choroidal Thickness in Keratoconus Patients: Perspectives in the Disease Pathophysiology

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          Abstract

          Purpose

          To analyze and compare choroidal thickness between keratoconus (KC) patients and age-matched non-KC subjects.

          Methods

          A cross-sectional, case-control study. One hundred and thirty-four keratoconic eyes and 78 control eyes, from individuals aged from 12 to 30 years old, were studied. Patients with KC followed in Corneal Department of Centro Hospitalar São João, Porto, Portugal, were identified and consecutively included between December 2017 and February 2018. A spectral-domain optical coherence tomography (OCT) using depth enhanced imaging was performed, and choroidal thickness in the center of the fovea and at 500  μm intervals along a horizontal section was measured and compared.

          Results

          The statistical analysis showed that keratoconic eyes present a thicker choroid in every measured location ( p < 0.05). Mean subfoveal choroidal thickness (SFCT) values obtained were 375.86 ± 89.29 and 322.91 ± 85.14 in keratoconus and control groups, respectively ( p < 0.001). In a multivariate analysis, SFCT was significantly associated with spherical equivalent ( p=0.004) and the presence of keratoconus ( p < 0.001), but not with age ( p=0.167), gender ( p=0.579), or best-corrected visual acuity ( p=0.178). In a “fixed model,” keratoconus patients were found to have a 67.55  μm (95% CI 36.61–98.49) thicker subfoveal choroid compared to controls.

          Conclusion

          Keratoconus patients seem to have a thicker choroid than healthy individuals. The exact pathophysiological mechanism resulting in a thicker choroid in KC patients is not known, but it could possibly be associated with inflammatory choroidal mechanisms.

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          Most cited references46

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          Enhanced depth imaging optical coherence tomography of the choroid in highly myopic eyes.

          To measure macular choroidal thickness (CT) in highly myopic eyes using enhanced depth imaging optical coherence tomography (OCT). Retrospective, observational case series. Enhanced depth imaging OCT images were obtained in highly myopic eyes (> or =6 diopters [D]). Images of CT were obtained by positioning a spectral-domain OCT device close enough to the eye to acquire an inverted image. CT was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 1000-mum intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Statistical analysis was performed to evaluate CT at each location and to correlate CT with age and refractive error. The mean age of the 31 patients (55 eyes) was 59.7 years (+/- 17.6 years; range, 24 to 90 years), and the mean refractive error was -11.9 D (+/- 3.7 D). The mean subfoveal CT was 93.2 microm (+/- 62.5 microm) and was correlated negatively with age (P = .006), refractive error (P < .001), and history of choroidal neovascularization (P = .013). Regression analysis suggested that subfoveal CT decreased by 12.7 mum for each decade of life and by 8.7 microm for each D of myopia. The choroid in highly myopic eyes is very thin and undergoes further thinning with increasing age and degree of myopia. Abnormalities of the choroid may play a role in the pathogenesis of myopic degeneration.
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            Keratoconus and related noninflammatory corneal thinning disorders

            Keratoconus and other noninflammatory corneal thinning disorders (keratoglobus, pellucid marginal degeneration and posterior keratoconus) are characterized by progressive corneal thinning, protrusion and scarring; the result is distorted and decreased vision. The etiology and pathogenesis of these disorders are unknown but may be associated with a variety of factors, including contact lens wear, eye rubbing, Down's syndrome, atopic disease, connective tissue disease, tapetoretinal degeneration and inheritance. Recent advances in techniques for biochemical and pathological investigation are now allowing further exploration in these areas. Early diagnosis is aided by the finding of irregular corneal astigmatism with inferior corneal steepening. Treatment ranges from simple spectacle correction to keratoplasty. In this review, the past and present literature on corneal thinning disorders is reviewed and practical approaches to diagnosis and management are outlined.
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              Choroidal thickness in polypoidal choroidal vasculopathy and exudative age-related macular degeneration.

              To compare choroidal thickness between eyes with polypoidal choroidal vasculopathy (PCV) and eyes with age-related macular degeneration (AMD). Observational, comparative case series. Twenty-five eyes with PCV, 14 uninvolved fellow eyes with PCV, 30 eyes with exudative AMD, 17 eyes with early AMD, and 20 eyes of age-matched normal subjects. Choroidal thickness was measured using enhanced-depth imaging optical coherence tomography. Subfoveal choroidal thickness in each eye was analyzed by measurement of the vertical distance from the Bruch's membrane to the innermost scleral layer. Nasal, superior, temporal, and inferior choroidal thicknesses, 1500 μm apart from the foveal center, were also evaluated in all eyes. Choroidal thickness in each group. Mean (± standard deviation) subfoveal choroidal thickness in eyes with PCV and in their uninvolved fellow eyes was 438.3±87.8 μm and 372.9±112.0 μm, respectively, which was significantly greater than in eyes of age-matched normal subjects (224.8±52.9 μm) (P<0.001 and P = 0.003, respectively). Subfoveal choroidal thickness of eyes with exudative AMD (171.2±38.5 μm) and eyes with early AMD (177.4±49.7 μm) was thinner than that of age-matched normal subjects (P = 0.004 and P = 0.078, respectively). Choroidal thickness at each of the other 4 points showed a similar tendency. This study demonstrates thickening of choroid in the eyes with PCV, in contrast with choroidal thinning observed in eyes with AMD. These findings suggest involvement of different pathogenic mechanisms in PCV from those in exudative AMD. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi
                2090-004X
                2090-0058
                2019
                3 December 2019
                : 2019
                : 2453931
                Affiliations
                1Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal
                2Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
                3Faculty of Medicine, University of Porto, Porto, Portugal
                4Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
                Author notes

                Academic Editor: Steven F. Abcouwer

                Author information
                https://orcid.org/0000-0002-7289-4045
                https://orcid.org/0000-0003-3820-4597
                Article
                10.1155/2019/2453931
                6913161
                31871781
                48203a77-a3f9-4d6e-8b7d-2e11d0b9d362
                Copyright © 2019 João Pinheiro-Costa et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 June 2019
                : 19 September 2019
                Categories
                Research Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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