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Evaluating keratoconus progression prior to crosslinking: maximum keratometry vs the ABCD grading system.

Riccardo Vinciguerra1, Michael W Belin, Alfredo Borgia

  • 1From the Humanitas San Pio X Hospital, Milan, Italy (R. Vinciguerra, Rosetta); The School of Engineering, University of Liverpool, Liverpool, United Kingdom (Vinciguerra); Department of Ophthalmology and Vision Science, University of Arizona, Tucson, Arizona (Belin); Humanitas Clinical and Research Center, IRCCS, Milan, Italy (Borgia, Piscopo, Montericcio, Confalonieri, Legrottaglie, P. Vinciguerra); Department of Biomedical Sciences, Humanitas University, Milan, Italy (P. Vinciguerra).

Journal of Cataract and Refractive Surgery
|November 12, 2020
PubMed
Summary

The ABCD Progression Display detected keratoconus progression earlier than maximum keratometry in over half of cases. This suggests updated criteria for earlier intervention in progressive keratoconus (KC).

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Area of Science:

  • Ophthalmology
  • Corneal Diseases
  • Refractive Surgery

Background:

  • Keratoconus (KC) is a progressive corneal ectasia leading to vision impairment.
  • Early detection of KC progression is crucial for timely intervention, such as corneal crosslinking (CXL).
  • Maximum keratometry (Kmax) is a standard metric, but its sensitivity in detecting early progression is debated.

Purpose of the Study:

  • To assess the correlation between changes in Kmax and ABC values from the ABCD Progression Display in progressive KC.
  • To determine if ABC values can detect KC progression earlier than Kmax.

Main Methods:

  • Retrospective analysis of 76 eyes from 63 patients undergoing CXL for progressive KC.
  • Kmax, ABC values, and thinnest point (ThCT) were recorded pre-CXL (T0) and at a prior follow-up (T-1).
  • For patients without Kmax progression, a T-2 examination was used to evaluate ABC parameter changes.

Main Results:

  • A moderate correlation was found between changes in Kmax and changes in A and B values (ρ = 0.391 and ρ = 0.339, respectively).
  • No significant correlation was observed between Kmax changes and changes in C or ThCT.
  • In 51.6% of cases with a T-2 examination, the ABCD Progression Display showed statistically significant progression not detected by Kmax.

Conclusions:

  • Changes in A and B values of the ABCD Progression Display correlate moderately with Kmax changes in progressive KC.
  • The ABCD Progression Display identified earlier progression in over half of the patients compared to Kmax.
  • These findings support revising progression criteria to enable earlier therapeutic interventions for KC.