Background:Ectasia development occurs due to a chronic corneal biomechanical decompensation or weakness, resulting in stromal thinning and corneal protrusion. This leads to corneal steepening, increase in astigmatism, and irregularity. In corneal refractive surgery, the detection of mild forms of ectasia pre-operatively is essential to avoid post-operative progressive ectasia, which also depends on the impact of the procedure on the cornea.Method:The advent of 3D tomography is proven as a significant advancement to further characterize corneal shape beyond front surface topography, which is still relevant. While screening tests for ectasia had been limited to corneal shape (geometry) assessment, clinical biomechanical assessment has been possible since the introduction of the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, USA) in 2005 and the Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) in 2010. Direct clinical biomechanical evaluation is recognized as paramount, especially in detection of mild ectatic cases and characterization of the susceptibility for ectasia progression for any cornea.Conclusions:The purpose of this review is to describe the current state of clinical evaluation of corneal biomechanics, focusing on the most recent advances of commercially available instruments and also on future developments, such as Brillouin microscopy.

Purpose: To evaluate the long-term efficacy and safety of iris-fixated foldable phakic intraocular lenses (pIOLs) for the management of myopia and astigmatism after 6-year follow-up. Setting: Ophthalmology Department, Hospital Braga, Portugal. Design: Retrospective cohort study. Methods: Patients included underwent iris-fixated foldable Artiflex pIOL implantation between January 2010 and December 2013. Follow-up evaluations were performed 6 months postoperatively and every 12 months until 72 months. Preoperative and follow-up data on uncorrected and corrected distance visual acuity (CDVA), manifest refraction, endothelial cell density (ECD), and anterior chamber depth (ACD) were analyzed. Results: A total of 177 eyes of 98 patients with a mean age of 32.33 ± 7.13 years were analyzed. There was a statistically significant improvement in CDVA from 0.09 ± 0.02 logMAR preoperatively to 0.04 ± 0.02 logMAR (P < .0001) at 6 years postoperatively. The spherical equivalent demonstrated a statistically significant improvement from −9.50 ± 2.93 diopters (D) to −0.41 ± 0.45 D at 6 years. At 72 months, the efficacy and safety indexes were 0.94 and 1.15, respectively. A mean loss of 31.77 cells/mm2 (1.19%) was observed each year until the sixth year. The overall mean ECD loss after correction for the physiological loss was 3.02% after 6 years. No correlations were observed between the mean ECD loss and the preoperative ACD. Conclusions: The Artiflex pIOL was a safe, effective, and a stable option to correct myopia. A mean ECD loss of 3.02% was observed over 6 years. No pIOL was explanted due to corneal decompensation.

Purpose To compare topometric (front surface curvature) and tomographic (3D corneal shape) indices for diagnosing keratoconus. Methods Pentacam data from one eye randomly selected of 200 normals (N) and 177 keratoconus (KC) were analyzed. Tomographic and topometric indices were tested. Receiver operating characteristic (ROC) curves were calculated, along with pairwise comparisons. Results All tested variables had significant differences among N and KC (Mann-Whitney, p < 0.001). Most accurate tomographic indices had higher AUC than best topometric ones (DeLong, p < 0.05). Belin-Ambrosio D (BAD-D) had AUC of 1.00 (sensitivity 100.0%; specificity 98.5%). Conclusion Tomographic data was superior than topometric data to detect keratoconus. The BAD-D was an enhanced approach for detecting keratoconus. How to cite this article Correia FF, Ramos I, Lopes B, Salomão MQ, Luz A, Correa RO, Belin MW, Ambrósio R Jr. Topometric and Tomographic Indices for the Diagnosis of Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):92-99.

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