Epithelial Thickness Mapping in Keratoconic Corneas: Repeatability and Agreement Between CSO MS-39, Heidelberg Anterion, and Optovue Avanti OCT Devices.

Abstract

To assess repeatability and agreement of corneal epithelial thickness mapping in eyes with keratoconus using three optical coherence tomography (OCT) devices featuring different technologies: spectral-domain (SD) OCT combined with Placido disk corneal topography (MS-39), swept-source OCT (Anterion), and SD-OCT (Avanti). Three consecutive measurements were acquired with the three devices in 60 eyes with keratoconus. The mean epithelial thickness was calculated in the central 2-mm zone and in 2- to 5-mm and 5- to 7-mm diameter rings. The repeatability was calculated using pooled within-subject standard deviation (Sw). The agreement was assessed by paired t tests and Bland-Altman plots. The repeatability (Sw) of the epithelial thickness for the central 2-mm zone was 0.91, 0.71, and 0.93 μm for the MS-39, Anterion, and Avanti, respectively. All thicknesses with the MS-39 were greater than those of the Anterion and Avanti, with mean differences of 4.11 ± 1.34 μm (P < .001) and 0.52 ± 1.30 μm (P = .003), respectively. The 95% limits of agreement were 1.484 to 6.736 μm for the MS-39 and Anterion, -3.068 to 2.028 μm for the Avanti and MS-39, and 1.258 to 5.922 μm for for the Avanti and Anterion. Epithelial thickness mapping results were most repeatable with the Anterion, followed by the MS-39 and Avanti. The MS-39 gave the thickest values, followed by the Avanti and Anterion. The differences were significant, making the devices not interchangeable for epithelial thickness mapping in eyes with keratoconus. [J Refract Surg. 2023;39(7):474-480.].