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    Adopting a multidiagnostic method for characterising the anterior segment

    Diagnostic platform provides measurement of objective refraction and ocular abberations


    Clinical cases

    We have reported some clinical cases to show the clinical applicability of this new multidiagnostic platform as follows.


    Case 1

    A 73-year-old patient with a diagnosis of Fuchs’ dystrophy had undergone cataract surgery recently and since then the endothelial corneal dystrophy had worsened. The analysis obtained with the VX120 system revealed the following information in one shot:

    ·      Significant narrowing of the anterior chamber in both eyes, especially in the left eye, as well as a central corneal thickening (Scheimpflug images, Figures 3 and 4);

    ·      Measurement of central corneal thickness in the right eye not obtained, suggesting the presence of a significant intraocular opacity that was confirmed with retroillumination images (Figure 4);

    ·      Identification of the location of the opacity at endothelial level in the central part of the cornea with the analysis of the Scheimflug image (Figure 4);

    ·      Presence of moderate amounts of astigmatism that could also be observed in the corneal topographic map, confirming that the main source of astigmatism in this patient is the cornea (Figure 3);

    ·      Great relevance of the aberrations of the anterior corneal surface in the total aberrometric pattern, although the internal aberrometric pattern in this specific case also showed a high level of influence over the ocular pattern, possibly due to the alterations of the posterior corneal surface as a consequence of the Fuchs’ dystrophy (Figure 5);

    ·      Low levels of IOP that could be biased due to the significant corneal oedema that was present. For this reason, the system always displays the measurement of central corneal thickness and IOP together, providing also a compensated IOP value considering this corneal thickness (Figure 3).


    Case 2

    In an asymptomatic 60-year-old man, the technology enabled an incipient corneal ectasia to be detected. Several years prior to this, the patient had undergone cataract surgery in both eyes with implantation of monofocal IOLs.


    The system allowed the following information to be obtained:

    ·      Presence of a low refractive error in both eyes (Figure 6);

    ·      In corneal topographic analysis, presence of an inferior-superior corneal asymmetry that was more marked in the left eye (Figure 6);

    ·      Keratoconus prediction index of 32% and 46% in the right and left eyes, respectively (Figure 6);

    ·      Reduced central corneal thickness, with some asymmetry in the distribution of the peripheral corneal thickness, especially in the left eye (Figure 7);

    ·      The corneal elevation map of the left eye allowed us to define clearly the location and dimension of the incipient corneal ectasia detected in the left eye (Figure 8);

    ·      Anomalous level of HOAs in the left eye (Figure 8) and for this reason the red alert sign HOA appeared on the initial screen once the measurement was taken (Figure 6). This is an alert to inform the clinician that the eye explored has an abnormal level of HOAs;

    ·      Some level of posterior capsular opacification detected in the analysis of retroillumination images in left eye, which can contribute further to the visual degradation that may be experienced in this eye (Figure 9).

    All this information, along with other data provided by the system, confirmed the presence of an incipient atypical keratoconus in the form of temporal-inferior ectasia. The system is therefore an excellent tool for the analysis and detection of ectatic corneal diseases, even when they are presented in atypical forms.

    Case 3

    A 42-year-man complained of a significant worsening of the vision of his right eye, especially at night, during the past 3 months. No refractive analysis was provided by the instrument in the right eye, although the corneal topographic, pachymetric and tonometric evaluation was obtained without problems (Figure 10).

    Considering that a measurement of ocular aberrations could not be obtained in the right eye, we suspected that a significant opacity was present in the central part of the crystalline lens (Figure 10). This was confirmed with the analysis of the retroillumination images, which showed a significant central posterior subcapsular opacification in the right eye and a mild level of opacification in the left eye (Figure 11).

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