PurposeTo assess the repeatability and reliability of the most important tomographic parameters for characterising keratoconus measured with a Pentacam HR (high resolution).MethodsOverall, 230 eyes in 158 patients with keratoconus were analysed. We performed five consecutive corneal tomography examinations for each eye with a Pentacam HR in patients with keratoconus. Study eyes were classified into three groups depending on the maximum posterior elevation (max_BFS_post): grade 1 for cases of keratoconus with a max_BFS_post of 40 µm; grade 2 for those with a max_BFS_post of between 41 and 75 µm and grade 3 for those with a max_BFS_post of over 75 µm. We calculated the intraclass correlation coefficients (ICCs) and repeatability limits of parameters from tomography and aberrometry.ResultsAll the parameters were found to have excellent ICCs (0.9). The repeatability limits for the key parameters were higher than 0.5D for the power parameters, 20° for the axis of corneal astigmatism and 10 µm for the thinnest corneal thickness. Further, we obtained repeatability limits of above 0.1 µm for the aberrometry values and overall greater than 15° for the coma axis. All the values increase with the severity of keratoconus, except for that of the coma axis which falls with keratoconus grade.ConclusionsThe reliability indicated by ICCs supports the view that the Pentacam HR is useful for the diagnosis of keratoconus. The repeatability limits suggest that new criteria should be established for monitoring progression taking into account the real measurements that can be made using this system.

The level of repeatability of the measurements obtained with a Pentacam HR confirms the usefulness of this system for the diagnosis of keratoconus. Nevertheless, it has certain limitations for monitoring individual progression of keratoconus and planning intrastromal corneal ring segment insertion.

Both visual acuity and VF-14 may improve after fitting Rose K2 XL contact lenses in patients with irregular corneas. In addition, in our patients, these lenses can be worn for a longer period than GP corneal contact lenses.

Purpose To assess the physiological changes in the cornea over time in patients with irregular cornea fitted with Rose K2 XL gas-permeable scleral contact lenses. Methods Prospective study of 16 eyes of patients who did not tolerate gas-permeable corneal contact lenses and were fitted with Rose K2 XL scleral lenses. We assessed the central vault and the corneal thickness centrally and at peripheral regions (2 to 5 mm annulus). All these measures were obtained by anterior segment optical coherence tomography. The measurements were taken immediately after fitting the lenses and 1, 6 and 12 months later. Prior to the study and at 1 year, we performed an objective test for diagnosing limbal stem cell deficiency (Limbokit). Results The mean vault was 201.7 ± 82.3 µm 20 min after fitting the contact lens; 189.4 ± 94.0 µm at 1 month; 165.1 ± 75.9 µm at 6 months and 142.1 ± 76.8 µm at 1 year, the values at 6 and 12 months being significantly different to baseline. After 1 year, the central corneal thickness had increased by 2.3% (IQR = 5.6), but the changes were only significant for the superior thickness. There is no limbal stem cell deficiency after 1 year of scleral contact lens use. Conclusions After use of Rose K2 XL scleral contact lenses, the corneal physiology of patients with an irregular cornea remains unchanged, as assessed by corneal thickness measurements and the Limbokit test. In all cases, however, the vault decreased over time.

Purpose: To report sterile corneal necrosis as a severe and rare complication after Bowman Layer Transplantation (BTL). Methods: A 35-year-old woman with Down syndrome and advanced progressive keratoconus in her left eye was scheduled for a BLT. The patient rubbed her eyes and did not tolerate contact lenses. Following standard technique, a 8mm Bowman layer graft was placed into a intrastromal pocket with no intraoperative complications. Results: Postoperatively, the patient remained stable and topography showed notable central flattening but 17 days after the BTL was performed she developed a sterile corneal necrosis. Conclusions: Many studies have proven the efficacy of this technique as a potential treatment for stabilizing progressive and advanced keratoconus in selected cases. Few complications associated with BTL have been reported, including Bowman Layer tears or buttonholes when obtaining the tissue, very thick grafts or postoperative hydrops but no sterile necrosis described to the date. A combination of the hypotheses raised in this paper may explain this undesirable event.