Abstract
PurposeTo characterize corneal structural changes in keratoconus using a new morphogeometric approach and to evaluate its potential diagnostic ability.MethodsComparative study including 464 eyes of 464 patients (age, 16 and 72 years) divided into two groups: control group (143 healthy eyes) and keratoconus group (321 keratoconus eyes). Topographic information (Sirius, CSO, Italy) was processed with SolidWorks v2012 and a solid model representing the geometry of each cornea was generated. The following parameters were defined: anterior (Aant) and posterior (Apost) corneal surface areas, area of the cornea within the sagittal plane passing through the Z axis and the apex (Aapexant, Aapexpost) and minimum thickness points (Amctant, Amctpost) of the anterior and posterior corneal surfaces, and average distance from the Z axis to the apex (Dapexant, Dapexpost) and minimum thickness points (Dmctant, Dmctpost) of both corneal surfaces.ResultsSignificant differences among control and keratoconus group were found in Aapexant, Aapexpost, Amctant, Amctpost, Dapexant, Dapexpost (all p<0.001), Apost (p = 0.014), and Dmctpost (p = 0.035). Significant correlations in keratoconus group were found between Aant and Apost (r = 0.836), Amctant and Amctpost (r = 0.983), and Dmctant and Dmctpost (r = 0.954, all p<0.001). A logistic regression analysis revealed that the detection of keratoconus grade I (Amsler Krumeich) was related to Apost, Atot, Aapexant, Amctant, Amctpost, Dapexpost, Dmctant and Dmctpost (Hosmer-Lemeshow: p>0.05, R2 Nagelkerke: 0.926). The overall percentage of cases correctly classified by the model was 97.30%.ConclusionsOur morphogeometric approach based on the analysis of the cornea as a solid is useful for the characterization and detection of keratoconus.
Highlights
Keratoconus is an ectatic corneal disorder characterized by progressive corneal thinning and structural weakening and resulting in corneal protrusion, irregular astigmatism, and decreased vision [1]
Our morphogeometric approach based on the analysis of the cornea as a solid is useful for the characterization and detection of keratoconus
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Summary
Keratoconus is an ectatic corneal disorder characterized by progressive corneal thinning and structural weakening and resulting in corneal protrusion, irregular astigmatism, and decreased vision [1]. Problems arises when very incipient stages of keratoconus are intended to be detected (subclinical keratoconus). In such cases, a more comprehensive analysis of corneal geometry is necessary as well as the consideration of other complementary descriptors, such as corneal aberrations, pachymetry, asphericity, or the analysis of corneal biomechanical properties [6,7,8,9,10,11,12,13,14]. The current study is a continuation of this research by confirming the diagnostic ability of the morphogeometric indices developed but in a larger sample of patients as well as by creating a new predictive model of detection of incipient keratoconus based on the combination of such indices
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