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    New study finds limits of keratometry in keratoconus

    Reproducibility of keratometry is better for early keratoconus than for advanced keratoconus, a new study showed.                  

    The study could help clinicians decide when to use corneal cross-linking in their efforts to stop the progression of the disease, wrote Tom H. Flynn, PhD, and his colleagues from the Corneal Service, Moorfields Eye Hospital, St. George’s Hospital, London. They published their finding in the British Journal of Ophthalmology.

    Cross-linking comes with some risks, including reported cases of persistent stromal haze, sterile infiltrates, corneal melt, and microbial keratitis, so clinicians would like to reserve the procedure for patients whose keratoconus is most likely to progress, they wrote. The challenge is identifying those patients.

    Current or recent progressions provide some of the best indications of future progression. Serial Scheimpflug corneal tomography is the standard practice to monitor progress of ecstasia. It works well for gross or moderate progression, but cannot always detect subtle progression.

    More from this author: Why intense glaucoma monitoring may be ineffective

    It is hard to tell which changes in parameters show real change in the patient and which are measurement error.

    The authors routinely look for the curvature measured at the steepest part of the cornea (Kmax), corneal thickness at the thinnest location (TCT) and K1 and K2.

    Previous studies on interobserver and intraobserver agreement in keratoconus have produced conflicting results. As a result, the authors undertook a new study to see how this type of variability might affect measuring the progression of keratoconus.

    They recruited 100 patients with keratoconus and used a Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany).

    All had Pentacam-derived Ansler-Krumeich stage 1 or greater. The researchers excluded patients under 18 years of age, patients who previously had surgery, and patients with corneal scarring.

    Each of two observers scanned the same eye of each subject. The eye to be scanned and the sequence of scans were randomly determined. Both observers were able to get high-quality scans of 93 patients.


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