ABSTRACT
Introducción: Globalmente, existe un aumento de la prevalencia del queratocono y su diagnóstico en edades tempranas. Se notifican un gran número de casos subclínicos y otros con una rápida progresión, condicionada por el inicio precoz de la enfermedad y la asociación a factores de riesgo. Objetivo: Describir los aspectos epidemiológicos, clínicos y el resultado de los medios de diagnóstico implicados en la detección precoz del queratocono infantil. Desarrollo: En niños con ametropía hay elementos que alertan la presencia de un queratocono como causa del defecto refractivo. Desde el punto de vista epidemiológico se encuentran: distribución geográfica, rol de la herencia y factores ambientales. Clínicamente se señalan los antecedentes de enfermedades, tales como las alergias, la presencia de miopía o astigmatismo miópico con inestabilidad refractiva y los signos clínicos relacionados con la progresión del cono. En los pacientes de riesgo es preciso realizar exámenes mediante diferentes medios de diagnóstico según su disponibilidad, siendo primordial el análisis refractivo, queratométrico y topográfico. Conclusiones: En la evaluación de los niños con ametropía se deben tener en cuenta elementos epidemiológicos y clínicos que permiten sospechar y diagnosticar precozmente el queratocono. En la interpretación de los resultados de los medios de diagnóstico involucrados en su detección, se deben considerar los hallazgos más frecuentes en la población infantil según el grado de progresión de la ectasia.
Introduction: Globally, there is an increase of the keratoconus prevalence and its diagnosis in early ages. A great number of subclinical cases and others with a quick progression are notified, conditioned by the early onset of the disease and the association with risk factors. Objective: To describe the epidemiological, clinical aspects and the result of diagnostic means involved in the early detection of infant keratoconus. Development: There are elements that alert the presence of a keratoconus as a cause of the refractive defect in children with ametropia. From the epidemiologic point of view they are: geographical distribution, heredity role and environmental factors. History of previous diseases are clinically pointed out, such as allergies, myopia or myopic astigmatism with refractive instability and the clinical signs related to cone progression. In risk patients it is necessary to carry out exams by means of different diagnostic means according to their availability, being essential the refractive, keratometric and topographic analysis. Conclusions: In the evaluation of children with ametropia, epidemiological and clinical elements should be taken into account that allow to suspect and early diagnose the keratoconus. In the interpretation of results of the diagnostic means involved in their detection the most frequent findings in the infant population, should be considered according to the ectasia degree of progression.
Subject(s)
Child , Keratoconus , Refractive Errors , Astigmatism , Corneal Topography , MyopiaABSTRACT
Objectives@#This study described the clinical profile of patients with keratoconus at a single tertiary referral hospital.@*Methods@#This was a single-center, retrospective, cross-sectional study that reviewed medical records of patients diagnosed with keratoconus from January 2015 to August 2022. Data on the clinical profile, intervention, and clinical outcomes were collected from the chart review. @*Results@#Forty (40) patients (79 eyes) were included in the study. Majority (98%) had bilateral disease in which 22 (55.5%) were affected asymmetrically. The mean age was 21 years. Most patients (72.5%) were male. Blurring of vision was the chief complaint in all patients. Atopy was present in 23 patients (57.5%). History of vigorous eye rubbing was present in 31 (77.5%). The mean interval from onset of symptoms to consult was 46.4 ± 33.38 months. The mean pinhole corrected distance visual acuity was 0.47 ± 0.41 (Snellen equivalent of 20/59). The average spherical equivalent was -7.48D ± 6.99D. Corneal protrusion on slit-lamp biomicroscopy was seen in 78 eyes (98.7%). Other findings included Fleischer ring (53.2%), Vogt's striae (19.0%), and apical corneal scar (24.0%). Only one eye (1.3%) had no corneal findings. Thirty-nine eyes (49.3%) were classified as advancedsevere keratoconus. Rigid contact lens was planned for 60 eyes (75.9%). Sixty-two eyes (78.5%) were for collagen cross-linking. Deep anterior lamellar keratoplasty was planned in 10 eyes (12.7%) and penetrating keratoplasty in two eyes (2.5%).@*Conclusion@#Keratoconus at the Philippine General Hospital was most frequently seen in young males and asymmetrically affects both eyes. Patients consulted relatively late and presented with a more advanced stage of the disease. History of ocular allergy and eye rubbing were significant risk factors. Improving awareness of this condition must be emphasized to detect keratoconus earlier.
Subject(s)
Keratoconus , Cornea , Demography , PhilippinesABSTRACT
El queratocono es una ectasia corneal bilateral asimétrica, en etapas iniciales no se evidencia la afectación binocular. El conocimiento del grado de asimetría en el queratocono pediátrico permite tomar decisiones oportunas en el manejo de los pacientes. Se realizó este trabajo con el objetivo de describir las características clínicas y el tratamiento de tres casos pediátricos con diferente grado de asimetría interocular del queratocono, atendidos en la consulta provincial de ectasias corneales pediátricas en Ciego de Ávila. Los pacientes mostraron diferencia entre ambos ojos de los signos clínicos, la refracción y las variables topográficas. Al paciente dos se le diagnosticó queratocono en un ojo, sin evidencias clínicas ni topográficas de la enfermedad en el ojo contralateral. Todos los pacientes mostraron astigmatismo miópico compuesto en ambos ojos y se les indicó corrección óptica. Al paciente uno se le corrigió con cristales, al dos con lentes de contacto rígidos de gas permeable y al tercero con piggyback en un ojo y lentes de contacto rígidos de gas permeable en el otro. Presentaron, además, una ambliopía asociada y se les orientó tratamiento oclusivo y tareas de visión cercana en los pacientes dos y tres. Es frecuente encontrar asimetría interocular en pacientes pediátricos con queratocono por la diferencia de progresión entre ambos ojos. El seguimiento periódico permite diagnosticar la enfermedad en el ojo contralateral en pacientes con diagnóstico de queratocono en un ojo, indicar una corrección óptica individualizada, sobre todo en presencia de anisometropía, y monitorizar la evolución de la ambliopía refractiva asociada con frecuencia(AU)
Keratoconus is an asymmetric bilateral corneal ectasia, in early stages binocular involvement is not evident. Knowledge of the degree of asymmetry in pediatric keratoconus allows timely decisions in patient management. This research was carried out with the objective of describing the clinical characteristics and the treatment of three pediatric cases with different degree of interocular asymmetry of keratoconus, treated in the provincial consultation of pediatric corneal ectasia in Ciego de Avila. Patients showed difference between both eyes in clinical signs, refraction and topographic variables. Patient two was diagnosed with keratoconus in one eye, with no clinical or topographic evidence of the disease in the contralateral eye. All patients showed compound myopic astigmatism in both eyes and optical correction was indicated. Patient one was corrected with glasses, patient two with rigid gas permeable contact lenses and patient three with piggyback in one eye and rigid gas permeable contact lenses in the other eye. They also presented an associated amblyopia and were directed occlusive treatment and near vision tasks in patients two and three. It is common to find interocular asymmetry in pediatric patients with keratoconus due to the difference in progression between the two eyes. Periodic follow-up makes it possible to diagnose the disease in the contralateral eye in patients diagnosed with keratoconus in one eye, to indicate individualized optical correction, especially in the presence of anisometropia, and to monitor the evolution of frequently associated refractive amblyopia(AU)
Subject(s)
Humans , Male , Female , Child , Astigmatism/etiology , Keratoconus/diagnosisABSTRACT
El queratocono es una afección inflamatoria, es una ectasia corneal que se caracteriza por un aumento de la curvatura corneal. Se describe como una enfermedad progresiva y asimétrica asociada con cambios estructurales en la organización del colágeno corneal. Existen diferentes opciones terapéuticas con el objetivo de estabilizar la superficie corneal, mejorar la visión y evitar su progresión. El sistema piggyback consiste en adaptar un lente rígido de gas permeable con alta permeabilidad al oxígeno sobre un lente de contacto hidrofílico, es ideal para pacientes que requieren la óptica de un lente de contacto rígido, pero tienen dificultades con su material. Se indica cuando existe una intolerancia a los lentes rígidos de gas permeable, en córneas irregulares y con curvaturas avanzadas. Se presenta una paciente de 24 años de edad con diagnóstico de queratocono desde los 10 años de edad que se corregía con lente rígido de gas permeable. Acudió a consulta del servicio de córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el año 2010 porque comenzó a presentar intolerancia a los lentes. Debido a que la paciente no presentaba criterio quirúrgico y tenía una agudeza visual mejor corregida con lentes de 1,0 en ambos ojos, se decidió realizar el tratamiento con piggyback corneal. Pese al seguimiento, como parte de la progresión de la enfermedad, a los 10 años de mantenerse con el piggyback, presentó un hidrops corneal agudo, el cual fue tratado. En la actualidad la paciente mantiene seguimiento anual por consulta, sin progresión del queratocono y sin complicaciones con el tratamiento de piggyback corneal(AU)
Keratoconus is an inflammatory condition, a corneal ectasia characterized by increased corneal curvature. It is described as a progressive and asymmetric disease associated with structural changes in the organization of corneal collagen. There are different therapeutic options to stabilize the corneal surface, improve vision and prevent progression. The piggyback system consists of fitting a rigid gas permeable lens with high oxygen permeability over a hydrophilic contact lens, it is ideal for patients who require the optics of a rigid contact lens, but have difficulties with its material. It is indicated when there is intolerance to rigid gas permeable lenses, in irregular corneas and with advanced curvatures. We present a 24-year-old female patient with a diagnosis of keratoconus since she was 10 years old, which was corrected with a rigid gas permeable lens. She went to the cornea service of the Cuban Institute of Ophthalmology Ramón Pando Ferrer, in 2010 because she began to present intolerance to lenses. Since the patient did not present surgical criteria and had a visual acuity better corrected with 1.0 lenses in both eyes, it was decided to perform corneal piggyback treatment. Despite the follow-up, as part of the progression of the disease, after 10 years of piggyback, she presented an acute corneal hydrops, which was treated. At present, the patient maintains annual follow-up via consultation, without progression of keratoconus and without complications with the corneal piggyback treatment(AU)
Subject(s)
Humans , Male , Young Adult , Keratoconus/diagnosisABSTRACT
Objetivo: Determinar parámetros aberrométricos de la córnea para la detección del queratocono subclínico. Métodos: Se realizó un estudio observacional, analítico de corte transversal que incluyó 36 pacientes con queratocono subclínico (grupo de estudio) y 36 estudiantes con córneas aparentemente sanas (grupo control), que asistieron a la consulta de córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre mayo de 2018 y junio de 2022. Se analizaron topografía y aberrometría corneal con el tomógrafo corneal Pentacam AXL. Resultados: El grupo queratocono subclínico mostró valores similares para la queratometría, asfericidad corneal, paquimetría y el valor total de desviación en comparación con el grupo normal. Hubo diferencias estadísticamente significativas en los parámetros aberrométricos, como el coma a 90º (Z3 -1), y la raíz cuadrada media de las aberraciones de alto orden, de cara anterior, posterior y total corneal, en queratocono subclínico en comparación con el grupo normal. El coma posterior a 90º presentó un área bajo la curva (0,894) mayor dentro de las aberrometrías, con un punto de corte de -0,013 µm, con sensibilidad del 86,1 por ciento y especificidad del 88,9 por ciento. Conclusiones: El coma posterior a 90º (parámetro aberrométrico) presenta una alta sensibilidad y especificidad para el diagnóstico de queratocono subclínico, mediante el análisis tomográfico Pentacam AXL(AU)
Objective: To determine corneal aberrometric parameters for the detection of subclinical keratoconus. Methods: An observational, analytical, cross-sectional study was performed including 36 patients with subclinical keratoconus (study group) and 36 students with apparently healthy corneas (control group), who attended the cornea consultation at the Cuban Institute of Ophthalmology Ramón Pando Ferrer, between May 2018 and June 2022. Corneal topography and aberrometry were analyzed with the Pentacam AXL corneal tomographer. Results: The subclinical keratoconus group showed similar values for keratometry, corneal asphericity, pachymetry and total deviation value compared to the normal group. There were statistically significant differences in aberrometric parameters, such as coma at 90° (Z3-1), and root mean square of high-order anterior, posterior and total corneal aberrations in subclinical keratoconus compared to the normal group. The 90° posterior coma presented a higher area under the curve (0.894) within the aberrometries, with a cutoff point of -0.013 µm, with sensitivity of 86.1 percent and specificity of 88.9 percent. Conclusions: Coma posterior to 90º (aberrometric parameter) presents high sensitivity and specificity for the diagnosis of subclinical keratoconus, using Pentacam AXL tomographic analysis(AU)
Subject(s)
Humans , Female , Cornea/abnormalities , Aberrometry/methods , Keratoconus/etiology , Observational Studies as TopicABSTRACT
Objetivo: Evaluar la densitometría corneal en pacientes con queratocono. Métodos: Se realizó un estudio observacional descriptivo de corte transversal que incluyó 90 pacientes con queratocono (grupo de estudio) y 30 estudiantes con córneas aparentemente sanas (grupo control), que asistieron a la consulta de córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre mayo del 2018 y junio del 2019. Se seleccionó el ojo derecho de cada caso. Se analizaron densitometría corneal con el tomógrafo corneal Pentacam AXL. Resultados: La densitometría fue mayor en el queratocono respecto a la córnea aparentemente sana, de 0 a 2 mm, en la capa anterior, central, y posterior, respectivamente (p < 0,001). La densitometría aumentó en los 0 a 2 mm en la capa anterior en el grupo moderado y en el grupo avanzado (p < 0,001), y entre los 2-6 mm en la capa central, de 10,86 ± 0,54 en el control, en el queratocono avanzado a 12,35 ± 1,16 y en el moderado a 12,16 ± 1,45 (p < 0,001). La densitometría aumentó en el avanzado de 27,64 ± 3,81, de 22,77 ± 2,14 en el leve, y de 24,04 ± 2,83 en el moderado y en los 0-2 mm, en la capa anterior. Conclusiones: La densitometría es mayor en la córnea queratocónica respecto a la córnea aparentemente sana, además que se incrementa al aumentar la gravedad del queratocono en el área central(AU)
Objective: To evaluate corneal densitometry in patients with keratoconus. Methods: A cross-sectional descriptive observational cross-sectional study was performed including 90 patients with keratoconus (study group) and 30 students with apparently healthy corneas (control group), who attended the cornea consultation at the Cuban Institute of Ophthalmology Ramón Pando Ferrer, between May 2018 and June 2019. The right eye of each case was selected. Corneal densitometry was analyzed with the Pentacam AXL corneal tomographer. Results: Densitometry was higher in keratoconus relative to apparently healthy cornea, from 0 to 2 mm, in the anterior, central, and posterior layer, respectively (p < 0.001). Densitometry increased in the 0 to 2 mm in the anterior layer in the moderate group and in the advanced group (p < 0.001), and between 2-6 mm in the central layer, from 10.86 ± 0.54 in the control, in the advanced keratoconus to 12.35 ± 1.16 and in the moderate to 12.16 ± 1.45 (p < 0.001). Densitometry increased in advanced from 27.64 ± 3.81, from 22.77 ± 2.14 in mild, and from 24.04 ± 2.83 in the moderate and 0-2 mm, in the anterior layer. Conclusions: Densitometry is higher in the keratoconic cornea with respect to the apparently healthy cornea, moreover it increases with increasing severity of keratoconus in the central area(AU)
Subject(s)
Humans , Densitometry/methods , Tomography, Optical Coherence/methods , Keratoconus , Epidemiology, Descriptive , Observational Studies as TopicABSTRACT
RESUMO Objetivo Identificar alterações de aberrometria de alta ordem em diferentes graus de ceratocone. Métodos Estudo transversal, retrospectivo, observacional. Foram analisados 54 pacientes (108 olhos) diagnosticados com ceratocone pelo mesmo especialista em córnea por meio dos critérios ABCD de Belin/Ambrósio Enhanced Ectasia, utilizando-se o tomógrafo Pentacam® HR 70900 (Oculus Wetzlar, Alemanha). Além disso, foram feitas análises qualitativa e quantitativa das aberrações de alta ordem desses mesmos pacientes por meio do OPD-Scan III-NIDEK. Resultados Por meio da avaliação de ambos os olhos dos pacientes com os critérios de Belin-Ambrósio, constatou-se presença de ceratocone em 34 pacientes. Ademais, por meio da análise estatística, constatou-se relação direta entre a asfericidade posterior e o desenvolvimento do ceratocone, com p<0,001 (referência: p<0,05). Por meio da análise do OPD-Scan III-NIDEK, as principais aberrações de alta ordem encontradas nos pacientes com ceratocone foram coma, trefoil e aberração esférica. Conclusão O raio da curvatura posterior é a primeira variável a se alterar com o desenvolvimento do ceratocone, o que se faz perceptível na análise da asfericidade posterior por meio o Pentacam®. Além disso, a alteração da paquimetria e da asfericidade posterior influencia diretamente o desenvolvimento de aberrações de alta ordem em pacientes com ceratocone.
ABSTRACT Objective To identify higher order aberrometry changes in different degrees of keratoconus. Methods Cross-sectional, retrospective, observational study. Fifty-four patients (108 eyes) diagnosed with keratoconus by the same corneal specialist using the Belin/Ambrósio Enhanced Ectasia ABCD criteria were analyzed, using the Pentacam® HR 70900 tomograph (Oculus Wetzlar, Germany). In addition, qualitative and quantitative analysis of higher order aberrations in these patients was performed using the OPD-Scan III-NIDEK. Results Through the evaluation of both eyes of the patients according to the criteria of Benin Ambrósio, the presence of KCN was verified in 34 patients. Furthermore, through statistical analysis, a direct relationship was found between posterior asphericity and the development of KCN; p<0.001 (reference: p<0.05). Through the analysis of the OPD scan, the main higher order aberrations found in patients with KCN were Coma, Trefoil and Spherical Aberration (AE). Conclusion The posterior curvature radius is the first variable to change with the development of the KCN, which is noticeable in the analysis of posterior asphericity in Pentacam. In addition, alterations in pachymetry and posterior asphericity directly influence the development of higher order aberrations in patients with KCN.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aberrometry/methods , Keratoconus/diagnosis , Visual Acuity , Medical Records , Cross-Sectional Studies , Retrospective Studies , Dilatation, Pathologic , Corneal Pachymetry , Observational StudyABSTRACT
RESUMO Objetivo: Analisar retrospectivamente as alterações na ceratometria e no astigmatismo corneano obtidas após cirurgia de implante de anel intraestromal, comparando o uso de um segmento de arco longo versus o implante de dois segmentos de comprimento de arco tradicional. Métodos: A partir de um estudo transversal, obtivemos os dados de 94 olhos de pacientes diagnosticados com ceratocone, que foram submetidos ao implante de anel corneano. Eles foram divididos em dois grupos, dependendo do tipo de implante recebido: Grupo A, um segmento de arco longo; Grupo B, dois segmentos tradicionais. Todos os segmentos implantados possuíam 250µ de espessura. Os dados do pré-operatório dos dois grupos foram comparados, para garantir que as amostras eram similares (as diferenças encontradas entre os dois grupos não eram estatisticamente significativas). As variáveis analisadas no pré e no pós-operatório foram acuidade visual com correção, ceratometria, astigmatismo corneano e refração. Resultados: A amostra que recebeu apenas um segmento de arco longo (Grupo A) obteve redução da ceratometria média de 4,42D (8,7%) e do astigmatismo corneano de 2,43D (40,4%). Já na amostra dos olhos que receberam dois segmentos de arco tradicional (Grupo B), houve redução média de 2,66D (5,1%) em relação à ceratometria média e redução média de 2,11D (34,8%) em relação ao astigmatismo corneano. A redução obtida na ceratometria média no Grupo A foi maior que a obtida no Grupo B (diferença estatisticamente significativa). A redução obtida no astigmatismo do Grupo A não foi estatisticamente significante, se comparada com o resultado obtido no Grupo B (considerando p≤0,05). Conclusão: Foi demonstrado que o uso de um segmento de arco longo possui maior capacidade de aplanação corneana, se comparado com o uso de dois segmentos com comprimento de arco tradicional. Em relação à redução do astigmatismo, os dois grupos mostraram resultados equivalentes.
ABSTRACT Purpose: To retrospectively analyze the changes in corneal keratometry and astigmatism after intrastromal ring surgery, comparing the use of one long arch segment versus two traditional arc length segments. Methods: A cross-sectional study obtained data from 94 eyes of patients diagnosed with keratoconus that underwent surgical treatment with corneal ring implant. They were divided into two groups according to the type of implant received: one long-arch segment (Group A) or two traditional segments (Group B), both 250 microns thick. Preoperative data from the two groups were compared to ensure that the samples were similar (the differences between the two groups were not statistically significant). The variables (pre and post-operatively) analyzed were: best corrected visual acuity, keratometry, corneal astigmatism and refraction. Results: Group A, which received one long arch segment, showed a Km decrease of 4.42D (8.7%) and a corneal astigmatism reduction of 2.43D (40.4%). Group B, where the eyes acquired two traditional arch segments, showed an average Km decrease of 2.66D (5.1%) and corneal astigmatism reduction of 2.11D (34.8%). The mean keratometry (Km) reduction obtained was statistically significant (p≤0.05) when comparing both groups (A and B). The mean corneal astigmatism reduction was not statistically significant (p≤0.05) when comparing both groups (A and B). Conclusions: One long-arch segment has been demonstrated to have a greater capacity to reduce corneal curvature when compared to the use of two traditional-sized arch segments. No significant differences were found regarding the reduction of corneal astigmatism after comparing the results obtained in both groups.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Prostheses and Implants , Corneal Stroma/surgery , Prosthesis Implantation/methods , Keratoconus/surgery , Refraction, Ocular , Astigmatism , Visual Acuity , Cross-Sectional Studies , Treatment Outcome , Corneal Topography , Corneal PachymetryABSTRACT
El queratocono es una enfermedad asimétrica, no inflamatoria de origen multifactorial donde diversos factores se ven involucrados; entre los cuales destacan factores genéticos, biomoleculares y ambientales. No precisa causa única por lo cual su tratamiento es variable y depende directamente de la etapa de la enfermedad. Objetivo. El objetivo del artículo es describir las alternativas terapéuticas para el queratocono y los factores de riesgo asociado a la enfermedad. Metodología. Para el desarrollo de la investigación se realizó una revisión bibliográfica de la literatura científica relacionados a las alternativas terapéuticas del queratocono incluyendo estudios observacionales, experimentales analíticos descriptivos. Se utilizo la base de datos PubMed, y Google scholar cuyos documentos fueron publicados entre 2013 a 2022 en idioma español e inglés; se utilizaron los términos MESH y DeCs: "Terapéutica" "queratocono" "factores de riesgo". Conclusión. En la actualidad existen numerosas alternativas terapéuticas, sin embargo, esta va a depender de la etapa de la enfermedad y el grado de afectación corneal. Los tratamientos van desde lentes de contacto hasta la cirugía de trasplante de la córnea. Se aconseja la cirugía lamelar como la mejor opción terapéutica y menores efectos secundarios, ya que, mostrando una rápida recuperación de la capacidad visual en comparación con las otras técnicas.
Keratoconus is an asymmetric, non-inflammatory disease of multifactorial origin where several factors are involved, among which genetic, biomolecular and environmental factors stand out. It does not have a single cause, so its treatment is variable and depends directly on the stage of the disease. Objective. The aim of this article is to describe the therapeutic alternatives for keratoconus and the risk factors associated with the disease. Methodology. For the development of the research, a bibliographic review of the scientific literature related to the therapeutic alternatives for keratoconus was carried out, including observational, experimental, analytical and descriptive studies. The PubMed database was used, and Google scholar whose documents were published between 2013 to 2022 in Spanish and English language; the terms MESH and DeCs: "Therapeutics" "keratoconus" "risk factors" were used. Conclusion. At present there are numerous therapeutic alternatives, however, this will depend on the stage of the disease and the degree of corneal involvement. Treatments range from contact lenses to corneal transplant surgery. Lamellar surgery is advised as the best therapeutic option and has the least side effects, showing a rapid recovery of visual ability compared to other techniques.
O queratocono é uma doença assimétrica, não-inflamatória, de origem multifatorial, onde vários fatores estão envolvidos, incluindo fatores genéticos, biomoleculares e ambientais. Ela não tem uma causa única, portanto seu tratamento é variável e depende diretamente do estágio da doença. Objetivo. O objetivo deste artigo é descrever as alternativas terapêuticas para o queratocono e os fatores de risco associados com a doença. Metodologia. Para o desenvolvimento da pesquisa, foi realizada uma revisão bibliográfica da literatura científica relacionada às alternativas terapêuticas para o queratocono, incluindo estudos observacionais, experimentais, analíticos e descritivos. Utilizamos o banco de dados PubMed e Google scholar cujos documentos foram publicados entre 2013 e 2022 em espanhol e inglês; usamos os termos MESH e DeCs: "Therapeutics" "keratoconus" "risk factors". Conclusão. Existem atualmente inúmeras alternativas terapêuticas, porém, isto dependerá do estágio da doença e do grau de envolvimento da córnea. Os tratamentos variam de lentes de contato a cirurgia de transplante de córnea. A cirurgia lamelar é aconselhada como a melhor opção terapêutica com os menores efeitos colaterais, mostrando uma rápida recuperação da capacidade visual em comparação com outras técnicas.
Subject(s)
Keratoconus , Training Support , Disease , LiteratureSubject(s)
Humans , Pediatricians , Keratoconus , Therapeutics , Vision, Ocular , Immunoglobulin E , Disease PreventionABSTRACT
ABSTRACT Purpose: Keratoconus presents certain specificities in pediatric patients compared with adults. The greatest challenge is because the disease is typically more severe and progresses faster in children. This retrospective study aimed to report crosslinking procedure in patients under 18 years of age and their follow-up for at least 24 months after the procedure. Methods: Overall, 12 eyes from 10 patients were studied and data, such as visual acuity with and without correction, maximum keratometry, corneal thickness, foveal thickness, and endothelial microscopy, were assessed at both preoperative and postoperative visits. Corneal crosslinking was performed in all patients. Results: A tendency toward reduced Kmax and improved Corrected Distance Visual Acuity at all postoperative moments. Only one of the 12 eyes exhibited increased Kmax of more than 1 D during a time frame longer than 12 months. Regarding pachymetry, a tendency for corneal thinning was observed in the first four months after surgery. Conclusion: Encouraging results were obtained regarding the stabilization of the disease, progression, and procedural safety, corroborating to other authors' findings. The significance of early diagnosis and short-term follow-up were highlighted.
RESUMO Objetivo: O ceratocone na população pediátrica apresenta algumas particularidades em relação à população adulta. O maior desafio é devido à doença ser geralmente mais severa e rapidamente progressiva em crianças. Métodos: Este artigo utiliza uma análise retrospectiva para relatar o uso do crosslinking em jovens menores de 18 anos e sua evolução pelo menos 24 meses após o procedimento. Foram estudados 12 olhos de 10 pacientes, e dados como acuidade visual com e sem correção, ceratometria máxima, espessura corneana, espessura foveal e microscopia endotelial avaliados no pré e pós-operatórios. O crosslinking corneano foi realizado em todos os pacientes pelo mesmo cirurgião. Resultados: Observou-se uma tendência de redução do valor do Kmax e melhora da acuidade visual corrigida em todos os momentos de pós operatório. Com relação à paquimetria, observou-se afinamento corneano do ponto mais fino, nos primeiros quatro meses de pós-operatório. Conclusão: Resultados encorajadores foram obtidos com relação à estabilização da doença, progressão e segurança do procedimento, corroborando com as conclusões de outros autores. A importância do diagnóstico precoce e do acompanhamento a curto prazo do paciente deve ser destacada.
Subject(s)
Adolescent , Adult , Child , Humans , Photochemotherapy , Keratoconus , Riboflavin/therapeutic use , Ultraviolet Rays , Retrospective Studies , Collagen/therapeutic use , Photosensitizing Agents/therapeutic use , Cornea , Corneal Topography , Cross-Linking Reagents/therapeutic use , Corneal Pachymetry , Keratoconus/surgery , Keratoconus/drug therapyABSTRACT
El nanoftalmo es una anomalía del desarrollo, de condición rara, siempre bilateral. Comúnmente se presenta con un patrón hereditario autosómico recesivo. Se presenta una paciente femenina de 49 años de edad, atendida en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", con antecedentes de queratocono, glaucoma y nanoftalmo (16 mm). Se realizó cirugía del cristalino y posteriormente la paciente presentó complicaciones, por lo que tuvo que ser intervenida por los Servicios de Glaucoma y Retina. Describimos el caso con el fin de contribuir a enfrentar futuras situaciones similares(AU)
Nanophthalmos is a rare, always bilateral developmental anomaly. It commonly follows an autosomal recessive inheritance pattern. A case is presented of a female 49-year-old patient attending Ramón Pando Ferrer Cuban Institute of Ophthalmology with a history of keratoconus, glaucoma and nanophthalmos (16 mm). Crystalline lens surgery was performed, after which the patient developed complications leading to a new intervention at the Glaucoma and Retina Services. The case is described with the purpose of contributing to the solution of similar future situations(AU)
Subject(s)
Humans , Female , Middle Aged , Cataract Extraction/methods , Glaucoma/diagnosis , Phacoemulsification/methods , Keratoconus/etiologyABSTRACT
RESUMO Objetivo: Avaliar a contagem endotelial da córnea em pacientes com ceratocone (KCN) por microscopia especular e correlacionar com o estágio do ceratocone. Métodos: Noventa e três olhos de 61 pacientes com KCN foram incluídos neste estudo transversal. Os olhos foram classificados nos estágios 1 a 4 de KCN de acordo com a classificação de Amsler-Krumeich utilizando ceratometria obtida pela topografia de córnea e leituras de paquimetria obtidas pela microscopia especular. Resultados: A idade variou de 12 a 43 anos, média ± (desvio padrão) 22,1 ± 6,7 anos. A ceratometria média variou de 42,25 a 71,4 D (53,0 ± 6,1 D). A paquimetria variou de 350 a 606 µm, (461,7 ± 47,1 µm). Em relação a classificação, 23 pacientes (24,7%) apresentavam estágio 1, 24 (25,8%) estágio 2, 5 (6,5%) estágio 3 e 41 pacientes (44,1%) estágio 4. Não foi observada correlação linear entre ceratometria média e contagem de células endoteliais (Coeficiente de correlação de Pearson = -0,05). Nos estágios iniciais a moderados de KCN, a média da contagem de células endoteliais foi 2738,3 ± 285,4 cel/mm2, enquanto no grupo de KCN avançado (estágios 3 e 4) foi 2670,6 ± 262,7 cel/mm2, p= 0,24. Conclusões: Não há correlação entre a contagem de células endoteliais e o estágio do KCN.
ABSTRACT Objective: To evaluate the corneal endothelial count in patients with keratoconus (KCN) by specular microscopy and correlate with the stage of keratoconus. Methods: Ninety-three eyes from 61 patients with KCN were included in this cross-sectional study. The eyes were classified into KCN stages 1 to 4 according to the Amsler-Krumeich classification using keratometry obtained by corneal topography and pachymetry readings obtained by specular microscopy. Results: Age ranged from 12 to 43 years, mean ± (standard deviation) 22.1 ± 6.7 years. The average keratometry ranged from 42.25 to 71.4 D, (53.0 ± 6.1 D). Pachymetry ranged from 350 to 606 µm, (461.7 ± 47.1 µm). Regarding the Amsler classification, 23 patients (24.7%) had stage 1, 24 (25.8%) stage 2, 5 (6.5%) stage 3 and 41 patients (44.1%) stage 4. No linear correlation was observed between mean keratometry and endothelial cell count (Pearson's correlation coefficient = -0.05). In the early to moderate stages of KCN, the mean endothelial cell count was 2738.3 ± 285.4 cell / mm2, while in the advanced KCN group (stages 3 and 4) it was 2670.6 ± 262.7 cell / mm2 , p = 0.24. Conclusions: No correlation was found between the endothelial cell count and the KCN stage.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Endothelial Cells , Keratoconus/diagnosis , Microscopy , Endothelium, Corneal , Cell Count , Cross-Sectional Studies , Corneal Topography , Corneal PachymetryABSTRACT
ABSTRACT We report a case of two twins for whom advanced keratoconus is present in one of the siblings and no clear sign of the disease could be found for the other.
RESUMO Relatamos um caso de dois gêmeos em que o ceratocone avançado está presente em um dos irmãos e nenhum sinal da doença foi encontrado no outro.
Subject(s)
Humans , Male , Adult , Keratoconus/diagnosis , Twins , Tomography , Visual Acuity , Corneal Diseases/diagnosis , Corneal Topography , Keratoconus/geneticsABSTRACT
RESUMO Objetivos: Traçar o perfil epidemiológico, clínico, evolução e desfechos dos pacientes com ceratocone diagnosticados no serviço de referência oftalmológica do estado de Santa Catarina, Brasil. Métodos: Foram analisados retrospectivamente os prontuários de todos os pacientes com ceratocone do setor de córnea do Hospital Regional de São José, entre Janeiro de 2016 e dezembro de 2018. Os seguintes dados foram extraídos: sexo, idade, estágio da doença, doenças sistêmicas, sintomas oftalmológicos, adaptação de lentes de contato, tratamentos prévios, melhor acuidade visual monocular, medidas ceratométricas, condutas oftalmológicas, desfechos clínicos. Resultados: Os prontuários de 267 pacientes foram avaliados. A média de idade foi de 23 anos (intervalo: 06 - 60 anos), 159 (59,55%) eram do sexo masculino. 12 (4,49%) pacientes já haviam realizado ceratoplastia penetrante; 22 (8,24%) haviam realizado crosslinking; 07 (2,62%) já possuíam implante de anel intraestromal. 81 (30,34%) pacientes já haviam adaptado lentes de contato. 168 (62,92%) possuíam acuidade visual corrigida, do melhor olho, igual ou superior a 20/40. Encontrou-se uma distribuição entre casos leves, moderados e graves de: 03 (1,12%), 78 (29,21%), 157 (58,80%), respectivamente. Ao longo do período, efetivaram-se 51 (73,9%) transplantes de córnea, 09 (90,0%) implantes de anel intraestromal, 35 (32,4%) crosslinking, 22 (23,4%) adaptações de lentes de contato; 205 (76,77%) pacientes perderam seguimento, 12 (4,49%) receberam alta. Conclusão: Os pacientes são em sua maioria jovens, com doença moderada a grave, e boa acuidade visual no melhor olho. Ainda assim, muitos receberam indicação de tratamento cirúrgico. A perda de seguimento clínico constitui um fator importante na qualidade da assistência oftalmológica desta população.
ABSTRACT Objectives: To describe the epidemiological and clinical profile, evolution and outcomes of keratoconus patients diagnosed in the ophthalmologic reference service of the state of Santa Catarina, Brazil. Methods: The medical records of all patients with keratoconus attended at the Cornea service of the Regional Hospital of São José, between January 2016 and December 2018 were retrospectively analyzed. The following data were extracted: sex, age, disease stage, systemic diseases, ophthalmological symptoms, adaptation of contact lenses, previous treatments, best monocular visual acuity, keratometric measurements, ophthalmological procedures, clinical outcomes. Results: The medical records of 267 patients were analyzed. The average age was 23 years (range: 06 - 60 years), 159 (59.55%) were male. 12 (4.49%) patients had already performed penetrating keratoplasty; 22 (8.24%) had performed crosslinking; 07 (2.62%) had already an intrastromal ring implant. 81 (30.34%) patients had already adapted contact lenses. 168 (62.92%) had best corrected visual acuity, of the better eye, equal to or greater than 20/40. A distribution between cases was found light, moderate and severe of: 03 (1.12%), 78 (29.21%), 157 (58.80%), respectively. Throughout the period, a total of 51 (73,9%) corneal transplants, were performed 09 (90,0%) intrastromal ring implants, 35 (32,4%) crosslinking, 22 (23,4%) contact lens adaptations were performed; 205 (76.77%) patients lost follow-up, 12 (4.49%) were discharged. Conclusion: The patients are mostly young, with moderate to severe illness and good visual acuity in the best eye. Even so many received a surgical management. The loss of clinical follow-up is an important factor in the quality of ophthalmic care in this population.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Tertiary Care Centers , Keratoconus/diagnosis , Keratoconus/epidemiology , Retrospective Studies , Cohort Studies , Observational StudyABSTRACT
RESUMO O artigo tem como objetivo descrever de forma prospectiva diferentes casos de ectasias altamente assimétricas (very asymmetric ectasia, VAE) para diferenciar formas subclínicas ou "frustas" do ceratocone (forme fruste keratoconus - FFKC) de casos de doença ectásica unilateral. O Caso 1 é um paciente de 39 anos, que admitiu ter coçado intensamente apenas o olho direito (OD) na juventude, se apresentando com ectasia unilateral tratada com sucesso por meio de implante de anel intraestromal em OD. O olho esquerdo (OE) apresentou-se normal ao exame completo por meio de propedêutica multimodal e acuidade visual não corrigida (AVsc) de 20/20, estável por mais de 5 anos, com TBI (tomography and biomechanical index) de 0.02. No Caso 2 é um paciente de 15 anos com ectasia clínica em OD, e OE com topografia normal, mas alterações tomográficas e biomecânicas, incluindo o TBI 0,56, caracterizarando a doença subclínica (FFKC). O Caso 3 é a mãe do paciente do Caso 2, de 46 anos, que se apresentou com presbiopia, sem qualquer histórico oftalmológico relevante. A AVsc foi de 20/20 em cada olho, topografia de Placido com leve encurvamento inferior, mas sem sinais definitivos de ectasia. A avaliação biomecânica e tomográfica revelou sinais de ceratocone em ambos os olhos, com TBI de 1,0 e 0,99. Esses três casos estão de acordo com a definição do consenso global e a hipótese de dois acertos (two-hit hypothesis), que ceratocone é uma doença bilateral, mas ectasia pode ocorrer por causa estritamente mecânica unilateralmente (ou em qualquer olho). A relevância da propedêutica multimodal é destacada, destacando-se a integração do estudo biomecânico e tomográfico com imagens de Scheimpflug.
ABSTRACT The article aims to prospectively describe different cases of highly asymmetric ectasia (very asymmetric ectasia, VAE) to differentiate subclinical or "frustrated" forms of keratoconus (forme fruste keratoconus - FFKC) from cases of unilateral ectatic disease. Case 1 is a 39-year-old patient with unilateral ectasia treated with an intrastromal ring implant. The contralateral eye was normal due to multimodal propaedeutics, stable for more than 3 years, with a TBI of 0.02. The patient admitted to having intensely scratched only his right eye in his youth. In Case 2, a 15-year-old patient with clinical ectasia in the right eye, had a left eye with normal topography and tomographic and biomechanical changes characterizing FFKC. Case 3 is the mother of the case 2 patient, aged 46, who presented with presbyopia, without any relevant ophthalmological history. Uncorrected visual acuity of 20/20 in each eye, Placido topography with slight lower curving, but without definitive signs of ectasia. The biomechanical and tomographic evaluation revealed signs of keratoconus in both eyes. These three cases are in accordance with the definition of the global consensus: keratoconus is a bilateral disease, but ectasia can occur because of strictly mechanical unilateral (in any eye). The relevance of multimodal refractive imaging is highlighted, with a focus on integrating biomechanical and tomographic assessments with Scheimpflug images.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Biomechanical Phenomena , Tomography/methods , Corneal Topography/methods , Dilatation, Pathologic , Keratoconus/diagnosis , Epidemiology, DescriptiveABSTRACT
ABSTRACT Purpose: To compare the severity and laterality of keratoconus according to allergic rhinitis, scratching and sleeping habits, and manual dexterity. Methods: Objective assessments regarding allergic rhinitis, eye itching, and sleeping position among patients with keratoconus (diagnosed based on corneal tomography) were conducted. Diagnostic criteria and classification were based on the Amsler-Krumeich classification. Results: Ocular pruritus was reported by 29 of 34 participants (85.29%). Eighteen participants (62.07%) reported equal scratching of both eyes, six (20.69%) more on the right eye, and five (17.24%) more on the left eye. Comparison of the main sleeping position and the eye with more severe presentation of the disease using Fisher's exact test revealed some correlations (0.567 and 0.568 in the right and left eye, respectively). However, these correlations were not statistically significant. Conclusions: The association between higher keratometry values and sleeping position appears to be more significant than that reported between keratometry and itching, or manual dexterity.
RESUMO Objetivo: Comparar a gravidade e a lateralidade do ceratocone de acordo com a rinite alérgica, os hábitos de coçar e dormir e a destreza manual. Métodos: Foram realizadas questões objetivas sobre rinite alérgica, prurido ocular e posição do sono em pacientes com ceratocone, diagnosticados com base na tomografia corneana. Esses exames foram analisados e classificados de acordo com a classificação de Amsler-Krumeich. Resultados: O prurido ocular foi referido por 29 (85,29%) dos 34 voluntários. Dezoito sujeitos (62,07%) relataram coçar ambos os olhos igualmente, 6 (20,69%) mais no olho direito e 5 (17,24%) mais no olho esquerdo. Comparando-se a posição de dormir principal e o olhos com apresentação mais grave da doença, foi encontrada alguma relação baseada no teste exato de Fisher (0,567 no olho direito e 0,568 no olho esquerdo), embora nenhuma comparação parecesse estatisticamente significante. Conclusões: A associação entre maiores valores de ceratometria e posição do sono parece ser mais importante do que entre ceratometria e prurido ou destreza manual.
Subject(s)
Humans , Cornea , Corneal Topography , Hypersensitivity , Keratoconus , Vision, Ocular , Keratoconus/diagnosisABSTRACT
RESUMO Objetivo: Avaliar a possibilidade de alterações precoces sugestivas de ectasia detectáveis no Pentacam em casos sutis de alergia ocular em crianças. Métodos: Análise retrospectiva de 49 prontuários, com paciente de ambos os sexos e idades entre 3 e 14 anos. Do total de crianças estudadas, 31 apresentavam alergia ocular grau 1, e 18 não apresentavam qualquer sinal ou sintoma de alergia ocular, servindo como controles. Avaliaram-se diversos índices do Pentacam. Resultados: Houve associação estatisticamente significativa nas variáveis "Df - variação do mapa da elevação anterior da córnea" e "Pentacam combinado", que podem estar relacionadas com a detecção precoce de ectasia corneana nesses pacientes. Conclusão: Houve relação causal entre a prevalência da alergia ocular e alterações tomográficas na córnea, sugestivas de ceratocone em alguns pacientes provavelmente suscetíveis, podendo ser considerado um fator de risco para essa complicação.
ABSTRACT Objective: To assess if early alterations detected by Pentacam in children suffering from mild ocular allergy are suggestive of ectasia. Methods: A retrospective analysis of 49 medical records of patients of both sexes, aged between 3 and 14 years was performed. In this sample, 31 children suffered from grade I ocular allergy, and 18 presented no signs or symptoms of ocular allergy and comprised the control group. Several Pentacam indexes were evaluated. Results: A statistically significant association was found in the variables "Df - variation of the anterior corneal elevation map" and "combined Pentacam", which can be related to the early detection of corneal ectasia in these patients. Conclusion: There was a causal relation between prevalence of ocular allergy and tomographic alterations on the cornea, suggestive of keratoconus in some probably susceptible patients, which may be considered a risk factor for this complication.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Conjunctivitis, Allergic/complications , Conjunctivitis, Allergic/etiology , Keratoconus/diagnosis , Keratoconus/etiology , Keratoconus/epidemiology , Retrospective Studies , Corneal Topography , Diagnostic Techniques, OphthalmologicalABSTRACT
ABSTRACT Objective: The objective was to evaluate the efficacy of gabapentin in the management of neuropathic pain in patients with keratoconus, who were treated with fast (10 minutes) epi-off corneal crosslinking (CXL). Methods: This was a prospective, double-blind, randomized study. The sample comprised patients with bilateral progressive keratoconus, aged 12 years or older, who underwent a bilateral epi-off corneal CXL (fast - 10 minutes) procedure. One group was given placebo orally, and the other group received gabapentin 600 mg orally, both preoperatively. The visual analogue scale (VAS) was applied to record postoperative pain up to 48 hours after procedure. The study was conducted at the Belotto Stock Centro Oftalmológico, in the city of Joaçaba, Santa Catarina, Brazil, from June 2018 to September 2019. Results: At no point in the study significant differences were observed between groups, in terms of pain intensity measured by means of the VAS questionnaire, or of opioid use (Paco®), though opioid consumption was 21% lower in the group receiving gabapentin. Conclusion: We concluded gabapentin has no efficacy in postoperative pain control after epi-off corneal CXL (fast - 10 minutes). Although there was no statistically significant difference, the group that received gabapentin suffered less pain, resulting in lower opioid consumption. UTN number: U1111-1256-0330.
RESUMO Objetivo: Avaliar a eficácia do uso da gabapentina no manejo da dor neuropática em pacientes portadores de ceratocone submetidos ao tratamento de crosslinking corneano epi-off fast de 10 minutos. Métodos: Tratou-se de pesquisa prospectiva, duplo-cega, randomizada. A amostra foi composta de pacientes com ceratocone progressivo bilateral, a partir dos 12 anos de idade, submetidos ao procedimento de crosslinking corneano acelerado epi-off fast de 10 minutos bilateral. Um grupo recebeu placebo via oral e o outro, gabapentina 600mg, via oral, ambos no pré-operatório. A Escala Visual Analógica foi aplicada para registrar a dor pós-operatória até 48 horas após o procedimento. A pesquisa foi realizada no período de junho de 2018 a setembro de 2019 em um centro oftalmológico. Resultados: Não foram observadas diferenças estatísticas significativas para ambos os grupos, tanto na intensidade da dor medida pela Escala Visual Analógica, como na redução do uso do opioide (Paco®), em qualquer horário analisado durante um período de 48 horas. No entanto, houve redução de 21% no consumo de opioides pelo grupo que fez uso da gabapentina. Conclusão: A gabapentina não demonstrou eficácia no controle da dor no pós-operatório do crosslinking corneano epi-off fast de 10 minutos. No entanto, observou-se que, mesmo não havendo diferença estatisticamente significativa, houve diminuição da dor no grupo em que foi usada a gabapentina, resultando na redução do consumo de opioides. Número UTN: U1111-1256-0330.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Pain, Postoperative/drug therapy , Cross-Linking Reagents/therapeutic use , Keratoconus/therapy , Riboflavin/therapeutic use , Ultraviolet Rays , Pain Measurement , Double-Blind Method , Administration, Oral , Prospective Studies , Surveys and Questionnaires , Collagen/metabolism , Photosensitizing Agents/therapeutic use , Cornea/metabolism , Eye Pain/drug therapy , Gabapentin/administration & dosage , Gabapentin/therapeutic use , Analgesics/therapeutic useABSTRACT
RESUMO Objetivo: Avaliar sensibilidade do volume corneano, asfericidade e índice D para o diagnóstico precoce de ceratocone. Métodos: Estudo transversal analítico, realizado entre dezembro de 2018 e outubro de 2020, no qual foram analisados os prontuários de 39 pacientes (78 olhos) diagnosticados com ceratocone por um único subespecialista em córnea, por meio dos critérios de Belin/Ambrosio Enhanced Ectasia. Os dados coletados foram: asfericidade anterior, asfericidade posterior, índice D e suas frações (Da, Db, Dt, Dp e Df). Os dados foram digitados e manipulados em Excel, para posterior tratamento utilizando o programa Statistical Package for Social Science do Windows, versão 21.0. As variáveis categóricas foram apresentadas como valor absoluto e percentual. Variáveis contínuas foram apresentadas como média ± desvio-padrão e mediana (intervalo de confiança de 95%). Resultados: Foram analisados 78 olhos, com idade média de 28,2±5,8 anos e porcentagem entre o sexo feminino e masculino de 59,0% e 41,0%, respectivamente. O índice D apresentou estreita relação com sua fração Db nos casos iniciais de ceratocone, enquanto a fração Dt apresentou tal relação de forma reduzida. Conclusão: A correlação entre o índice D e sua fração Db sugere alterações precoces na elevação corneana posterior, colaborando para o diagnóstico de ceratocone subclínico.
ABSTRACT Objective: To assess sensitivity of corneal volume, corneal asphericity, and D index in early diagnosis of keratoconus. Methods: A cross-sectional analytical study, carried out between December 2018 and October 2020, which analyzed the medical records of 39 patients (78 eyes) diagnosed as keratoconus by a single corneal specialist, using the criteria of Belin-Ambrosio Enhanced Ectasia Display. The collected data were anterior asphericity, posterior asphericity, D index and its parameters (Da, Db, Dt, Dp and Df). The data were entered and handled in Excel, for later data treatment using the software Statistical Package for Social Science, version 21.0, for Windows. The categorical variables were presented as absolute value and percentages. The continuous variables were presented as mean±standard deviation, and median (95% of confidence interval). Results: We analyzed 78 eyes, mean age of 28.2±5.8 years, 59.0% of sample were female, and 41.0%, male. The D index showed a close relation to its Db parameter in the cases of keratoconus at early stage, while Dt parameter showed a reduced relation. Conclusion: The correlation between the D index and its Db parameter suggests early changes in the posterior corneal elevation, contributing to early diagnosis of subclinical keratoconus.