concomitant keratoconus and fuchs dystrophy: two diseases is better than just one?

Rio de Rio de Janeiro Janeiro Corneal Corneal

Tomography Tomography andand

BiomechanicsBiomechanicsStudy GroupStudy Group

CONCOMITANT KERATOCONUS

AND FUCHS DYSTROPHY:TWO DISEASES IS BETTER TWO DISEASES IS BETTER

THANTHANJUST ONE?JUST ONE?

Dr. Ambrósio is consultant for Oculus Optikgeräte GmbH (Wetzlar, Germany)

Isaac C. Ramos, Isabela Delpizzo,Bruno de F. Valbon, Leonardo N.

Pimentel, Diogo L. Caldas, Ana Laura C. Canedo,

Renato Ambrósio Jr.




Introduction

While thinning is a hallmark of ectatic

diseases, thickening is the consequence of

endothelial failure. Thereby, keratoconus and

Fuchs Dystrophy may “neutralize” each other in

the pathophysiologic process.

KeratoconusKeratoconus Corneal GuttataCorneal Guttata Keratoconus +Keratoconus +Corneal GuttataCorneal Guttata

Corneal ThicknessCorneal ThicknessCorneal Thickness




Purpose

To compare the visual performance,

along with tomographic and biomechanical

findings among cases with keratoconus and

cases with concomitant keratoconus and

corneal guttata.




Methods

Visual performance, along with

tomographic and biomechanical findings

were compared among 21 eyes from 21

patients with Keratoconus (group 1) and 22

eyes from eleven patients with concomitant

keratoconus and corneal guttata (group 2). The non-parametric Wilcoxon–Mann–

Whitney test was used to assess different

distributions among paired groups.




Methods Twenty-two eyes from eleven patients with concomitant keratoconus and corneal guttata (group 2) were confirmed by clinical examination, specular microscopy and Scheimpflug based corneal tomo-graphy. Non contact tonometry and biomechanical analysis was also performed with ORA.

Camel’s second hum sign




Results There was a statistically lower K2, keratometric astigmatism and pachymetric progression indices (min, ave and max) in the keratoconus and guttata group compared to the group with keratoconus (Wilcoxon-Mann-Whitney test, p<0.05).

K K+G

K2

P = 0.0491

K K+G

Min 43,6 42,4Avg 48,19 46,08

Max 61,1 53,5

P = 0.0026

K K+G

K K+GMin 0,4 0,1Avg 3,83 1,63Max 8,1 4,9

∆k




Results There was a statistically lower K2, keratometric astigmatism and pachymetric progression indices (min, ave and max) in the keratoconus and guttata group compared to the group with keratoconus (Wilcoxon-Mann-Whitney test, p<0.05). PPI Min PPI Avg PPI MaxP = 0.04 P = 0.0012 P = 0.0022

K K+G K K+G K K+G

K K+GMin 0,34 0,2Avg 1,17 0,83Max 2,15 2,03

K K+GMin 0,61 0,7Avg 1,73 1,24Max 2,49 2,73

K K+GMin 0,81 0,88Avg 2,50 1,79Max 3,96 4,67




ResultsExample case with keratoconus in OD (normal

endothelium) and relatively normal tomography

in the left eye with endothelial changes on

specular microscopy.

Sagital Map Elevation Back Map Sagital Map Elevation Back Map

OD OS




Results

There was no statistically difference in CRF and CH (p = 0,9516; p = 0,7986) between groups 1 and 2.

KeratoconusKeratoconus Keratoconus + Corneal GuttataKeratoconus + Corneal Guttata

CRF CHMin 3,9 3,1Avg 7,75 8,43Max 12,6 12,8

CRF CHMin 3,4 4,1Avg 7,67 8,23Max 11,3 10,9

Signal TimeResponse

Signal TimeResponse




Results The group with keratoconus and corneal guttata showed statistically better CDVA (Corrected Distance Visual Acuity) than keratoconus group.(Wilcoxon-Mann-Whitney test, p<0.05)

P = 0.0047

CDVA (LogMAR)

K K+G

K KGMin 0.06 0Avg 0.34 0.20Max 1 1.90

LogMAR Snellen

0.34 20/44

0.20 20/32




Conclusions

The concomitance of keratoconus

and endothelial disease seems to

reduce the severity of ectasia which is

observed on corneal tomo-graphy, but

it does not affect biomechanical

measurements.

The visual performance on the

group with concomitant keratoconus

and corneal guttata was better than

the group with keratoconus.

concomitant keratoconus and fuchs dystrophy: two diseases is better than just one?

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