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Differentiation Between Pellucid-Like Keratoconus and Pellucid Marginal Degeneration Using Swept-Source Optical

Janine Lenk1, Robert Herber, Lutz E Pillunat

  • 1Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.

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Distinguishing pellucid-like keratoconus (PLK) from pellucid marginal corneal degeneration (PMD) is challenging. While standard tomographic and biomechanical tests are insufficient, swept-source optical coherence tomography (SS-OCT) aids differentiation by revealing characteristic limbal thinning in PLK.

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Area of Science:

  • Ophthalmology
  • Corneal Imaging
  • Biomechanical Analysis

Background:

  • Pellucid-like keratoconus (PLK) and pellucid marginal corneal degeneration (PMD) are corneal ectasias with overlapping clinical presentations.
  • Accurate differentiation is crucial for appropriate patient management and treatment planning.
  • Current tomographic and biomechanical assessments often struggle to reliably distinguish between PLK and PMD.

Purpose of the Study:

  • To evaluate the efficacy of swept-source optical coherence tomography (SS-OCT) in differentiating PLK from PMD.
  • To compare corneal tomographic and biomechanical parameters between PLK and PMD groups classified by SS-OCT.

Main Methods:

  • Patients were classified into PLK (n=30) and PMD (n=10) groups using SS-OCT imaging.
  • Corneal thickness was measured at multiple positions using SS-OCT.
  • Tomographic, densitometric, and biomechanical parameters were assessed using Scheimpflug-based methods.

Main Results:

  • The PMD group was significantly older than the PLK group (P=0.002).
  • Astigmatism was significantly higher in the PMD group compared to the PLK group (P<0.001).
  • No significant differences were found in Kmax or biomechanical parameters (e.g., CBI) between the groups (P>0.05).
  • Significant differences in corneal thickness ratios were observed inferiorly and at the 6 and 7 o'clock positions between PLK and PMD (P<0.001).

Conclusions:

  • Scheimpflug-based tomographic and biomechanical parameters alone cannot reliably differentiate between PLK and PMD.
  • SS-OCT is valuable for distinguishing PLK from PMD due to its ability to detect characteristic peripheral corneal thinning.
  • Peripheral corneal pachymetry analysis using SS-OCT aids in the differential diagnosis of these conditions.