Abstract
Keratoconus (KC) is the most common corneal ectasia characterized by progressive corneal thinning, protrusion, and irregular astigmatism. The Amsler–Krumeich classification based on the analysis of corneal topography, corneal thickness, refraction and biomicroscopy is the most commonly used; recently, a new classification based on anterior segment Optical Coherence Tomography was introduced by Sandali and colleagues. Since there is no information about the possible agreement between these two classifications, the aim of this study is to compare the stratification of consecutive KC patients using the Amsler–Krumeich and Sandali classifications, and to further ascertain KC cases in which one classification is preferred over the other. Overall, 252 eyes of 137 patients (41.45 ± 16.93 years) were analyzed: in 156 eyes (61.9%), the Amsler and Sandali staging differed in one stage while in 75 cases (29.8%) it differed in two or more stages. In 222 eyes (88.1%), the Sandali staging was higher compared to the Amsler one. These results show that the two classifications are not fully interchangeable: the Amsler–Krumeich classification is more appropriate in identifying and longitudinally monitoring patients with early stages of KC, while the Sandali classification for the diagnosis and follow-up of patients with more advanced stages, particularly when a surgical planning has to be chosen.
Highlights
Keratoconus (KC) is a corneal disorder characterized by ectasia and thinning of the cornea, which often causes high and irregular myopic astigmatism [1]
Placido disc-based corneal topography is a sensitive and specific diagnostic tool that examines the anterior surface of the cornea but not the posterior corneal curvature, which is crucial in the early detection of KC
According to the Sandali classification, the studied eyes are divided as follows: stage 1 (n = 206 eyes, 81.7%), stage 2 (n = 16 eyes, 6.4%) which was subdivided into stage 2A (n = 9 eyes, 3.6%) and stage
Summary
Keratoconus (KC) is a corneal disorder characterized by ectasia and thinning of the cornea, which often causes high and irregular myopic astigmatism [1]. The initial classifications were based on the detection of irregular corneal astigmatism by means of a placid disc or the Javal ophthalmometer, along with the presence of characteristic signs in the biomicroscopic examination of the cornea [3]. Placido disc-based corneal topography is a sensitive and specific diagnostic tool that examines the anterior surface of the cornea but not the posterior corneal curvature, which is crucial in the early detection of KC. The anterior protrusion and the corneal shape parameter changes can be assessed, since they are different from the curvature map assessments of the relative distortions of the cornea, and can provide useful diagnostic information for the detection of KC [6]
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