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Dubinsky-Pertzov B, Segal O, Hecht I, Gazit I, Or L, Shemer A, Pras E, Einan-Lifshitz A. Predictive accuracy of the ABCD progression display among patients with keratoconus: A historic cohort analysis. Eye (Lond) 2023; 37:1834-1839. [PMID: 36127423 PMCID: PMC10275891 DOI: 10.1038/s41433-022-02242-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/30/2022] [Accepted: 09/05/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the accuracy of the ABCD Progression Display and the ABCD grading system in a population of adult patients with keratoconus. METHODS A retrospective cohort analysis of all adult patients with keratoconus followed at the Shamir Medical Center between 2012 and 2017. A recommendation by the cornea specialist to undergo corneal crosslinking (CXL) was used as a surrogate of ectasia progression. The ABCD grading was not available to the treating physician and was computed post-hoc. Sensitivity and specificity of the ABCD Progression Display was calculated, and multivariate regression was used to estimate the risk to undergo CXL when the ABCD Progression Display indicated progression. The ABCD grading was compared between patients who required CXL to those who did not. A single eye of each patient was included. Sensitivity and specificity of the ABCD Progression Display were 82% and 73%, respectively. A multivariable model adjusted for possible confounders, found that ABCD Progression was associated with a 7-fold risk of undergoing CXL compared to a patient in whom progression was not recorded in the ABCD Progression Display (OR = 7.55; 95% CI = 3.82-14.93, p < 0.001). RESULTS 293 eyes of 293 patients were analysed. Mean age at presentation was 26.92 ± 6.12 years. In 68 eyes, progression of keratoconus was recorded and CXL was performed (CXL-group). CONCLUSION The ABCD Progression Display demonstrated adequate sensitivity and specificity and high predictive capabilities of keratoconus progression. It can be effectively utilized as an initial screening test in adults with keratoconus.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Omri Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Gazit
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Or
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Shemer
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf-Harofeh), Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Arnalich-Montiel F, Fuente C, Auladell C, Ortiz-Toquero S. Detecting True Change in Keratoconus after Intracorneal Ring Segment Implantation. Life (Basel) 2023; 13:life13040978. [PMID: 37109508 PMCID: PMC10142878 DOI: 10.3390/life13040978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Confirming the progression of keratoconus is of paramount relevance to providing the appropriate treatment. Real change should be considered consistent over time. It must be greater than the variability of the measurement of the device used to monitor the cornea. The present study aimed to assess the intraobserver repeatability and intersession reproducibility of a Scheimpflug camera in measuring corneal parameters in virgin keratoconus and intrastromal corneal ring segments (ICRS) implantation eyes to discriminate real change from measurement noise. Sixty keratoconus and 30 ICRS eyes were included. Corneal parameters were determined in three consecutive measurements and were repeated 2 weeks later. The precision within the same session for all parameters was better in the keratoconic eyes, with mean repeatability limits 33% narrower (range 13% to 55%) compared with ICRS eyes. Mean reproducibility limits were 16% narrower (range +48% to -45%) compared with ICRS eyes. The cutoff values to consider a real corneal shape change were lower for virgin keratoconic than for ICRS, except for the thinnest corneal thickness and Stage C (ABCD system), which were the opposite. Corneal tomography measurements in ICRS eyes showed worse accuracy than in virgin keratoconus, which should be taken into account by practitioners in patients' follow up.
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Affiliation(s)
- Francisco Arnalich-Montiel
- Department of Ophthalmology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo Km 9, 100, 28034 Madrid, Spain
| | - Carlota Fuente
- Department of Ophthalmology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo Km 9, 100, 28034 Madrid, Spain
| | - Clara Auladell
- Department of Ophthalmology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo Km 9, 100, 28034 Madrid, Spain
| | - Sara Ortiz-Toquero
- Department of Ophthalmology, Ramón y Cajal University Hospital, Carretera de Colmenar Viejo Km 9, 100, 28034 Madrid, Spain
- Optometry Research Group, IOBA-Eye Institute, Department of Theoretical Physics, Atomic and Optics, University of Valladolid, 47011 Valladolid, Spain
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Haciagaoglu S, Tanriverdi C, Keskin FFN, Tran KD, Kilic A. Allograft corneal ring segment for keratoconus management: Istanbul nomogram clinical results. Eur J Ophthalmol 2022; 33:11206721221142995. [PMID: 36464653 DOI: 10.1177/11206721221142995] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To evaluate the clinical feasibility and visual outcomes of allograft corneal ring segment implantation for the treatment of keratoconus. METHODS This case series, included forty-four eyes of 32 patients with a 6-month follow-up. All cases were treated according to the Istanbul nomogram. In the Istanbul Nomogram, corneal tunnels of 4 × 7.5 mm diameters are created at depth of 200 μm and implanted with sterile allograft corneal rings (KeraNaturalTM, Lions VisionGift, Portland, OR, USA) at the cone location. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and keratometric values were compared preoperatively versus postoperatively. RESULTS There was significant improvement in UDVA, CDVA, SE and topographic keratometric values. The mean preoperative CDVA (Snellen, decimal) increased from 0.29 ± 0.20, to 0.56 ± 0.26 (P < 0.001), at the last visit. There was no statistically significant difference between preoperative and postoperative thinnest pachymetry values (P = 0.509). No major complications or adverse event were observed during and after the operation. CONCLUSIONS The results of this pilot study show that sterile allograft corneal ring segments may be safe, effective and enhance the visual performance of keratoconus patients. Larger clinical studies are needed to demonstrate the effectiveness and safety with long term follow-up.
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Affiliation(s)
- Sezer Haciagaoglu
- Faculty of Medicine, Department of Ophthalmology, Medipol University, Istanbul, Turkey
| | - Cafer Tanriverdi
- Faculty of Medicine, Department of Ophthalmology, Medipol University, Istanbul, Turkey
| | | | | | - Aylin Kilic
- Faculty of Medicine, Department of Ophthalmology, Medipol University, Istanbul, Turkey
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Danesh Z, Sedaghat MR, Momeni-Moghaddam H, Yekta AA, Belin MW. Corneal Stability and Visual Acuity 1 Year After Corneal Cross-linking Assessed Using the ABCD Keratoconus Staging System. J Refract Surg 2021; 37:700-706. [PMID: 34661479 DOI: 10.3928/1081597x-20210712-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess corneal stability and corrected distance visual acuity (CDVA) 3, 6, and 12 months following corneal cross-linking (CXL) using the ABCD keratoconus staging system. METHODS This prospective longitudinal study included 31 eyes with keratoconus receiving CXL based on the standard Dresden protocol. CDVA, refraction, and Scheimpflug tomography with the Pentacam HR (Oculus Optikgeräte GmbH) were evaluated before and after surgery. Geometric and functional changes were assessed using the actual values and staging of each element of the ABCD keratoconus staging system. A, B, C, and D refer to the anterior and posterior radii of curvature in a 3-mm zone centered on the cor-neal thinnest point, minimum corneal thickness, and CDVA, respectively. RESULTS There were no significant changes in the actual values of anterior radius of curvature (P = .497) and CDVA (P = .082), whereas posterior radius of curvature (P = .007) and corneal thinnest point (P < .001) showed significant changes statistically. Pairwise comparison showed only a statistically significant steepening in posterior radius of curvature at 3 months after CXL compared to the preoperative radius (P = .002) and a significant decrease in corneal thinnest point at 3 (P < .001) and 6 (P = .028) months after CXL compared to baseline assessment. Staging of each element of the ABCD keratoconus staging system indicated no change between baseline and 3, 6, and 12 months after CXL. CONCLUSIONS The geometric and functional parameters included in the ABCD keratoconus staging system showed stability of corneal status and CDVA 1 year after CXL. [J Refract Surg. 2021;37(10):700-706.].
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Dubinsky-Pertzov B, Reinhardt O, Gazit I, Or L, Hecht I, Pras E, Einan-Lifshitz A. The ABCD Keratoconus Grading System-A Useful Tool to Estimate Keratoconus Progression in the Pediatric Population. Cornea 2021; 40:1322-1329. [PMID: 34481408 DOI: 10.1097/ico.0000000000002632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/24/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the ABCD grading system in pediatric keratoconus. METHODS A retrospective cohort analysis of all children with keratoconus followed up at the Shamir medical center between 2010 and 2017. A recommendation by the treating physician to undergo corneal crosslinking (CXL) was used as an estimate for clinically significant disease progression. The ABCD grading was not available to the treating physician and was computed post hoc. The ABCD grading was compared between patients who required CXL with those who did not. A single eye of each patient was included. RESULTS Fifty eyes of 50 children were analyzed. The mean age at presentation was 15.56 ± 1.36 years. In 23 eyes, progression of keratoconus was recorded and CXL was performed (CXL-group). On presentation, the stable and CXL groups did not differ significantly in their clinical parameters. In the CXL-group, a statistically significant increase was seen in the ABCD staging (P < 0.001). In the stable group, the ABCD staging did not change significantly in parallel visits (P = 0.87). An increase of 1 point in the sum of the ABCD staging showed a 5-fold risk for undergoing CXL (odds ratio = 5.28; 95% CI, 1.82-15.34). There was no significant change in the Amsler-Krumeich classification in the CXL group. CONCLUSIONS Among a cohort of pediatric patients with keratoconus, worsening in the ABCD grading was associated with disease progression, whereas no significant change was demonstrated in the Amsler-Krumeich classification The ABCD grading system is a useful tool for initial assessment of disease progression in the pediatric population, in which early recognition is of paramount importance.
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Affiliation(s)
- Biana Dubinsky-Pertzov
- Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Utine CA, Özizmirliler D, Kayabaşı M, Günenç Ü. The number of intracorneal ring segments in asymmetric and central cones. EYE AND VISION (LONDON, ENGLAND) 2021; 8:10. [PMID: 33785054 PMCID: PMC8010988 DOI: 10.1186/s40662-021-00234-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/07/2021] [Indexed: 12/03/2022]
Abstract
Background To compare the results of single versus double intracorneal ring segment (ICRS) (KeraRing) implantation in keratoconus with respect to different cone locations. Methods Twenty-two eyes of 18 patients with totally asymmetric cones (20–80% or 0–100% distribution along steep axis) were implanted with single ICRS (Group 1), 38 eyes of 32 patients with central or partially asymmetric cones (50–50% or 40–60% distribution along steep axis) were implanted with double ICRS (Group 2), at a depth of 80% of the site of implantation, in channels created with femtosecond laser device. All patients had uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively) of ≤ 0.3 Snellen lines. Results In both groups, patients had median UDVA and CDVA gain of 3 Snellen lines (P > 0.05). Postoperative improvement in indices of vertical asymmetry and height decentration in Group 1; simulated keratometry, corneal astigmatism and anterior corneal asphericity values in Group 2 were greater (P < 0.05). A total of 10 eyes (45.5%) in Group 1 were recommended double ring implantation by the manufacturer’s nomogram, but underwent single ICRS implantation and achieved visual, refractive, tomographic outcomes comparable to that in Group 2, although corneal cylindrical correction was less and final topographic astigmatism was greater. Conclusion Double ICRS implantation seems to be superior in terms of keratometry, corneal astigmatism and anterior corneal asphericity improvement. Single ICRS implantation in totally asymmetric cones seems to provide satisfactory visual, refractive and tomographic results, similar to double ICRS implantation in central and partially asymmetric cones, by inducing central shift of the cone.
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Affiliation(s)
- Canan Asli Utine
- Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad, No:1606 Inciraltı Kampusu, Balcova, 35330, Izmir, Turkey. .,Izmir Biomedicine and Genome Center, Izmir, Turkey.
| | - Denizcan Özizmirliler
- Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad, No:1606 Inciraltı Kampusu, Balcova, 35330, Izmir, Turkey
| | - Mustafa Kayabaşı
- Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad, No:1606 Inciraltı Kampusu, Balcova, 35330, Izmir, Turkey
| | - Üzeyir Günenç
- Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad, No:1606 Inciraltı Kampusu, Balcova, 35330, Izmir, Turkey
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Flockerzi E, Xanthopoulou K, Goebels SC, Zemova E, Razafimino S, Hamon L, Jullien T, Klühspies U, Eppig T, Langenbucher A, Seitz B. Keratoconus staging by decades: a baseline ABCD classification of 1000 patients in the Homburg Keratoconus Center. Br J Ophthalmol 2020; 105:1069-1075. [DOI: 10.1136/bjophthalmol-2020-316789] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
Abstract
BackgroundThis retrospective cross-sectional study aims to analyse the keratoconus (KC) stage distribution at different ages within the Homburg Keratoconus Center (HKC).Methods1917 corneae (1000 patients) were allocated to decades of age, classified according to Belin’s ABCD KC grading system and the stage distribution was analysed.Results73 per cent (n=728) of the patients were males, 27% (n=272) were females. The highest KC prevalence occurred between 21 and 30 years (n=585 corneae, 294 patients). Regarding anterior (A) and posterior (B) curvature, the frequency of A was significantly higher than B in all age groups for stage 0, 1 and 2 (A0>B0; A1>B1; A2>B2; p<0.03, Wilcoxon matched-pairs test). There was no significant difference between the number of A3 and B3, but significantly more corneae were classified as B4 than A4 in all age groups (p<0.02). The most frequent A|B combinations were A4|B4 (n=451), A0|B0 (n=311), A2|B4 (n=242), A2|B2 (n=189) and A1|B2 (n=154). Concerning thinnest pachymetry (C), most corneae in all age groups were classified as C0>C1>C2>C3>C4 (p<0.04, Wilcoxon matched-pairs test). For the best distance visual acuity (D), a significantly higher number of corneae were classified as D1 compared to D0 (p<0.008; D1>D0>D2>D3>D4).ConclusionThe stage distributions in all age groups were similar. Early KC rather becomes manifest in the posterior than the anterior corneal curvature whereas advanced stages of posterior corneal curvature coincide with early and advanced stages of anterior corneal curvature. Thus, this study emphasises the necessity of posterior corneal surface assessment in KC as enabled by the ABCD grading system.
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Zhang X, Munir SZ, Sami Karim SA, Munir WM. A review of imaging modalities for detecting early keratoconus. Eye (Lond) 2020; 35:173-187. [PMID: 32678352 DOI: 10.1038/s41433-020-1039-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Early identification of keratoconus is imperative for preventing iatrogenic corneal ectasia and allowing for early corneal collagen cross-linking treatments to potentially halt progression and decrease transplant burden. However, early diagnosis of keratoconus is currently a diagnostic challenge as there is no uniform screening criteria. We performed a review of the current literature to assess imaging modalities that can be used to help identify subclinical keratoconus. METHODS A Pubmed database search was conducted. We included primary and empirical studies for evaluating different modalities of screening for subclinical keratoconus. RESULTS A combination of multiple imaging tools, including corneal topography, tomography, Scheimpflug imaging, anterior segment optical coherence tomography, and in vivo confocal microscopy will allow for enhanced determination of subclinical keratoconus. In patients who are diagnostically borderline using a single screening criteria, use of additional imaging techniques can assist in diagnosis. Modalities that show promise but need further research include polarization-sensitive optical coherence tomography, Brillouin microscopy, and atomic force microscopy. CONCLUSIONS Recognition of early keratoconus can reduce risk of post-refractive ectasia and reduce transplantation burden. Though there are no current uniform screening criterion, multiple imaging modalities have shown promise in assisting with the early detection of keratoconus.
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Affiliation(s)
- Xuemin Zhang
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Saleha Z Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Syed A Sami Karim
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Wuqaas M Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
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Anatomical and Visual Effects of the MyoRing Implantation Measured by the ABCD Keratoconus Grading System. Eye Contact Lens 2020; 46:52-56. [DOI: 10.1097/icl.0000000000000595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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