Evolution on Keratoconus and Corneal Ectatic Diseases: Paradigms and Paradoxes

Salomão, Marcella Q.; Lopes, Bernardo; Faria-Correia, Fernando

doi:10.5005/ijkecd-5-3-iv

Cited by 2 publications

(1 citation statement)

References 49 publications

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“…2 The damage accrued over time, however, may be severely visually disabling and may require corneal transplantation. Fortunately, current management strategies, 15 including early detection, regular monitoring, the use of specialty contact lenses and the appearance of stabilizing treatments to prevent KC progression, have reduced the number of patients proceeding to transplantation. [16][17][18] One landmark treatment is corneal cross-linking (CXL), which can effectively stabilize the cornea, although it requires evidence demonstrating the presence of such progression.…”

Section: Introductionmentioning

confidence: 99%

Baseline Findings in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) Project

Jiménez‐García

Dhubhghaill

Koppen

et al. 2020

Cornea

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Purpose: To present the baseline data for a large cohort of patients with keratoconus enrolled in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) study. Methods: Eight centers contributed the Scheimpflug tomographical data for 906 patients with keratoconus, 743 measured with a Pentacam and 163 with a Galilei. The stage of keratoconus at baseline, the location of the reference points, minimum pachymetry (Pmin), and maximum keratometry (Kmax) were analyzed. The intereye asymmetry was evaluated for Kmax (anterior and posterior), Pmin, and keratoconus stage. Average maps and elevation profiles were calculated for each degree of keratoconus. Results: Keratoconus was more frequently diagnosed in men (73%) than in women (27%). At baseline, 500/1155 eyes (43%) presented with moderate to severe changes in the posterior surface, whereas moderate/severe changes were only found in 252 and 63 eyes when evaluating anterior surface and pachymetry, respectively. The location of Pmin was usually inferotemporal (94% OD and 94% OS), while the location of Kmax showed more variability and significantly higher distance from apex (P < 0.05). The keratoconus presentation was chiefly asymmetric for all the parameters studied. Clear differences between stages could be identified in the maps and elevation profiles. Conclusions: The staging map set presented can be used as a graphical guidance to classify keratoconus stage. Keratoconus presented asymmetrically, and generally the posterior surface was more affected than the anterior surface or the thickness. Asymmetry is playing a role in KC detection. Although Pmin was almost invariably located inferotemporally, Kmax location showed higher variability and distance from the apex.

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Section: Introductionmentioning

confidence: 99%

Baseline Findings in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) Project

Jiménez‐García

Dhubhghaill

Koppen

et al. 2020

Cornea

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Evolution of Keratoconus: From Diagnosis to Therapeutics

Imbornoni

McGhee

Belin

2018

Klin Monatsbl Augenheilkd

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This review describes the evolution of the diagnosis and treatment of keratoconus from the earliest written description to present day. The first description was provided in 1736 by Benedict Duddell who described the prominent corneas of a fourteen-year-old boy. Throughout the 19th century, a variety of surgical procedures were proposed to manage the disease, such as surgically repositioning the pupil away from the cone, iris incarceration to produce a slit-like pupil, cauterization of the cone to produce a scar, and full thickness elliptical excision of the cone. Despite the ingenuity of these procedures, many led to serious complications. In 1936, Ramon Castroviejo revolutionized surgical management by performing the first corneal transplant for keratoconus. The advent of refractive surgery in the 1990s brought about a sudden and critical need for better understanding of keratoconus and corneal ectatic disease. Topographic analysis allowed for earlier detection of keratoconus, prior to clinical signs and symptoms. Tomographic analysis provided analysis of the anterior and posterior surfaces of the cornea and allowed for even earlier detection. The Belin/Ambrosio Enhanced Ectasia Display on the Pentacam incorporates anterior and posterior elevation, pachymetric map, best fit sphere and enhanced reference surface to provide an overall "D" value that is predictive of ectatic disease. This display allows refractive providers to quickly and accurately screen potential refractive surgery candidates to identify those at risk for ectasia and early subclinical keratoconus. Corneal crosslinking was revolutionary in the treatment of keratoconus. There have been several randomized controlled trials that have found it to be safe and effective to halt ectatic progression. Crosslinking was recently approved by the FDA for progressive keratoconus. Currently, there is no clear definition of ectasia progression. Providers must be able to clearly, objectively and consistently diagnose progressive disease to institute timely treatment in the population with the greatest potential benefit. The new Belin ABCD grading system and progression analysis incorporated into the Oculus Pentacam software provides an objective way of assessing progression over time. Keratoconus diagnosis and management have grown tremendously since the first description in 1736, but there is still much to learn about keratoconus and its management.

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Evolution on Keratoconus and Corneal Ectatic Diseases: Paradigms and Paradoxes

Cited by 2 publications

References 49 publications

Baseline Findings in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) Project

Baseline Findings in the Retrospective Digital Computer Analysis of Keratoconus Evolution (REDCAKE) Project

Evolution of Keratoconus: From Diagnosis to Therapeutics

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