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    Corneal tomography: Beyond but not in lieu of topography


    “The TBI was demonstrated to be more accurate for detecting ectasia than both the tomography-derived Belin/Ambrósio Deviation score and the biomechanical information alone, and external validation studies were performed in India, Germany, Iran, US, and Brazil using data from several independent patient populations,” Dr. Ambrósio said.
    Published case reports further illustrate the value of including tomography and biomechanical assessments for the diagnostic evaluation of patients in clinical practice. One such report described a case of unilateral ectasia identified in a patient who had been referred for treatment of keratoconus in his right eye.14 Unilaterality of the ectatic disease was confirmed by extensive diagnostic evaluation including Placido disk-based corneal topography, Scheimpflug corneal tomography, ocular wavefront analysis, and corneal segmental tomography with epithelial thickness mapping by very high frequency digital ultrasound and spectral domain OCT.

    “Interestingly, the patient admitted that he was rubbing the right eye,” Dr. Ambrósio said.

    “We know that ectasia can occur in any eye, but as we established in the global consensus, although keratoconus can be asymmetric, it is always bilateral.”

    Another report presented the case of a patient who developed post-LASIK ectasia despite being considered at low risk based on preoperative topographic evaluation.12 Findings from corneal tomographic and biomechanical measurements identified ectasia risk in the fellow unoperated eye (Figure 1).

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