The interrelationships between the 3 keratoconic cone parameters suggest that the thinner cones are largely central, that is, decenter less, but show greater steepening.
Aim: To propose a new system of keratoconus staging using a set of parameters describing the keratoconic cone. Materials and methods: Retrospective case series study of 101 keratoconic eyes of 58 patients was undertaken. They all had complete eye examination including corneal topography (Oculus Pentacam). K mean , K max , higher order aberrations (HOAs) root mean square (HOARMS) value, pachymetry at thinnest point and steepest corneal meridian were obtained from Pentacam. Apex to thinnest pachymetry distance (D) was calculated using trigonometry. Pearson correlation coefficients between K max and HOARMS, between D on the one hand and the adjusted angle of steepest meridian, K mean and K max respectively on the other, were calculated. Results: There is a statistically significant positive correlation between K max and HOARMS (p < 0.00001). There is a negative correlation, a "horizontalization," of the steep meridian with D increase, although it fell short of statistical significance (p = 0.07). D and K mean (p = 0.003), and D and K max (p = 0.005) are significantly negatively correlated. Conclusion: K max correlates with significant changes in HOAs. D correlates with corneal astigmatic meridian change and has a divergent path to K mean and to K max. We propose a new keratometry, decentration, and thinnest pachymetry staging using the parameters K max (K), distance from the corneal apex to the thinnest pachymetry point (D), and corneal thickness at its thinnest point (T) to give a better, detailed description of a keratoconic cornea which could lead to improvements in assessment of its severity and treatment outcomes.
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