Impact of classifying keratoconus location based on keratometry or pachymetry on progression parameters

This study sought to assess the impact of classifying keratoconus location based on thinnest pachymetry or maximum keratometry (Kmax) on progression parameters after corneal crosslinking (CXL).

In this observational study, patients were followed up at one, three, six and 12 months after CXL. All patients underwent visual acuity, Scheimpflug tomography and slitlamp assessment at all follow-ups. Keratoconus was classified as central, paracentral and peripheral based on X and Y co-ordinates of either thinnest pachymetry (Group 1) or Kmax (Group 2). Progression parameters Kmax, ABCD grading, anterior, posterior and total wavefront (WF) aberrations were compared between the groups.

Fifty-two eyes (43 patients) were classified into Groups 1 and 2: there were 82.8 per cent, 13.4 per cent, 3.8 per cent and 42.3 per cent, 38.4 per cent, 19.2 per cent central, paracentral and peripheral cones respectively. Central cones: Group 1: 'C' decreased after three months, Kmax, 'A', anterior and total WF decreased after six months. Group 2: Kmax, anterior and total WF decreased after three months, 'A' decreased at 12 months, whereas 'C' increased from three months. Paracentral cones: Group 1: no significant changes. Group 2: Kmax and 'A' decreased after six months, 'C' increased after three months. Peripheral cones: Group 1: no significant changes. Group 2: 'C' increased only at one month.

Thinnest pachymetry and Kmax should not be used interchangeably when categorising keratoconus. Although keratoconus may have thin cornea centrally, the Kmax may not be central. For the majority of parameters considered for monitoring progression, changes were noticed earlier when the keratoconus was classified based on Kmax.