Comparative evaluation of tomographic and biometric characteristics in bilateral keratoconus patients with unilateral corneal Vogt’s striae: a contralateral eye study

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Abstract

Purpose

The aim of this study was to evaluate and compare tomographic and biometric characteristics measured by the corneal tomography and ocular biometry in bilateral keratoconus (KCN) patients with and without corneal Vogt’s striae.

Methods

Ninety-two eyes of 46 subjects with a reliable diagnosis of bilateral KCN with unilateral Vogt’s striae were enrolled in this cross-sectional contralateral eye study. In addition to refraction (calculated by vectorial analysis) and visual acuity, corneal tomographic measurements were obtained by the Pentacam (Scheimpflug-based anterior segment tomography). Also, ocular biometric characteristics were evaluated using the Ocuscan ^® RxP (ultrasound biometer). The KCN eyes were categorized into two groups, including eyes with Vogt’s striae and eyes without Vogt’s striae.

Results

Our results showed significant differences in the sphere, cylinder, spherical equivalent, J0, corrected and uncorrected distance visual acuity, flat, steep and maximum keratometry, anterior chamber depth (ACD), and central corneal thickness (CCT) between the two groups (all P<0.001). The eyes without Vogt’s striae had a shorter ACD measured by the Pentacam and biometer. There were no differences in axial length (AL) and vitreous length (VL) between the two groups (all P>0.05). Also, there was poor agreement between the measurements of the Pentacam and ultrasound biometer for ACD in the study groups.

Conclusion

Corneal tomographic and ocular biometric measurements showed significant differences between KCN eyes with and without Vogt’s striae except for AL and VL. These differences should be noticed in clinical evaluations and treatment of KCN patients.

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Most cited references 31

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Keratoconus: a review.

Miguel Romero-Jiménez, Jacinto Santodomingo-Rubido, James S Wolffsohn (2010)

Keratoconus is the most common primary ectasia. It usually occurs in the second decade of life and affects both genders and all ethnicities. The estimated prevalence in the general population is 54 per 100,000. Ocular signs and symptoms vary depending on disease severity. Early forms normally go unnoticed unless corneal topography is performed. Disease progression is manifested with a loss of visual acuity which cannot be compensated for with spectacles. Corneal thinning frequently precedes ectasia. In moderate and advance cases, a hemosiderin arc or circle line, known as Fleischer's ring, is frequently seen around the cone base. Vogt's striaes, which are fine vertical lines produced by Descemet's membrane compression, is another characteristic sign. Most patients eventually develop corneal scarring. Munson's sign, a V-shape deformation of the lower eyelid in downward position; Rizzuti's sign, a bright reflection from the nasal area of the limbus when light is directed to the limbus temporal area; and breakages in Descemet's membrane causing acute stromal oedema, known as hydrops, are observed in advanced stages. Classifications based on morphology, disease evolution, ocular signs and index-based systems of keratoconus have been proposed. Theories into the genetic, biomechanical and biochemical causes of keratoconus have been suggested. Management varies depending on disease severity. Incipient cases are managed with spectacles, mild to moderate cases with contact lenses and severe cases can be treated with keratoplasty. This article provides a review on the definition, epidemiology, clinical features, classification, histopathology, aetiology and pathogenesis, and management and treatment strategies for keratoconus. 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

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Keratoconus.

Y S Rabinowitz (1998)

Keratoconus is a bilateral noninflammatory corneal ectasia with an incidence of approximately 1 per 2,000 in the general population. It has well-described clinical signs, but early forms of the disease may go undetected unless the anterior corneal topography is studied. Early disease is now best detected with videokeratography. Classic histopathologic features include stromal thinning, iron deposition in the epithelial basement membrane, and breaks in Bowman's layer. Keratoconus is most commonly an isolated disorder, although several reports describe an association with Down syndrome, Leber's congenital amaurosis, and mitral valve prolapse. The differential diagnosis of keratoconus includes keratoglobus, pellucid marginal degeneration and Terrien's marginal degeneration. Contact lenses are the most common treatment modality. When contact lenses fail, corneal transplant is the best and most successful surgical option. Despite intensive clinical and laboratory investigation, the etiology of keratoconus remains unclear. Clinical studies provide strong indications of a major role for genes in its etiology. Videokeratography is playing an increasing role in defining the genetics of keratoconus, since early forms of the disease can be more accurately detected and potentially quantified in a reproducible manner. Laboratory studies suggest a role for degradative enzymes and proteinase inhibitors and a possible role for the interleukin-1 system in its pathogenesis, but these roles need to be more clearly defined. Genes suggested by these studies, as well as collagen genes and their regulatory products, could potentially be used as candidate genes to study patients with familial keratoconus. Such studies may provide the clues needed to enable us to better understand the underlying mechanisms that cause the corneal thinning in this disorder.

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Baseline findings in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study.

Julie Jameson, K Zadnik, David J. Sterling … (1998)

To describe the baseline findings in patients enrolled in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. This is a longitudinal observational study of 1209 patients with keratoconus enrolled at 16 clinical centers. Its main outcome measures are corneal scarring, visual acuity, keratometry, and quality of life. The CLEK Study patients had a mean age of 39.29+/-10.90 years with moderate to severe disease, assessed by a keratometric-based criterion (95.4% of patients had steep keratometric readings of at least 45 D) and relatively good visual acuity (77.9% had best corrected visual acuity of at least 20/40 in both eyes). Sixty-five percent of the patients wore rigid gas-permeable contact lens, and most of those (73%) reported that their lenses were comfortable. Only 13.5% of patients reported a family history of keratoconus. None reported serious systemic diseases that had been previously reported to be associated with keratoconus. Many (53%) reported a history of atopy. Fifty-three percent had corneal scarring in one or both eyes. Baseline findings suggest that keratoconus is not associated with increased risk of connective tissue disease and that most patients in the CLEK Study sample represent mild to moderate keratoconus. Additional follow-up of at least 3 years will provide new information about the progression of keratoconus, identify factors associated with progression, and assess its impact on quality of life.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Ophthalmol

Journal ID (iso-abbrev): Clin Ophthalmol

Journal ID (publisher-id): Clinical Ophthalmology

Title: Clinical Ophthalmology (Auckland, N.Z.)

Publisher: Dove Medical Press

ISSN (Print): 1177-5467

ISSN (Electronic): 1177-5483

Publication date Collection: 2018

Publication date (Electronic): 07 August 2018

Volume: 12

Pages: 1383-1390

Affiliations

[1 ]Cornea Research Center, Khatam-Al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

[2 ]Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran, asgarifarshad@ 123456yahoo.com

[3 ]Department of Optometry, School of Rehabilitation Sciences, Zahedan University of Medical Sciences, Zahedan, Iran

Author notes

Correspondence: Farshad Askarizadeh, Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Vakil-abad Street, Mashhad 9177948964, Iran, Tel +98 912 143 9961, Fax +98 215 541 8080, Email asgarifarshad@ 123456yahoo.com

Article

Publisher ID: opth-12-1383

DOI: 10.2147/OPTH.S169266

PMC ID: 6086105

SO-VID: 6e4e92bb-7d19-4d08-9695-9276ff33e71e

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Comparative evaluation of tomographic and biometric characteristics in bilateral keratoconus patients with unilateral corneal Vogt’s striae: a contralateral eye study

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Conclusion

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Karger: Ophthalmology

Most cited references 31

Keratoconus: a review.

Keratoconus.

Baseline findings in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study.

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