Role Of Epithelial Mapping In Detection Of Early Keratoconus With Normal Posterior Elevation Parameters

To assess the effectiveness of a keratoconus-detection algorithm derived from AS-OCT MS39 (CSO, Italy) epithelial thickness maps in the fellow eye from a series of patients with unilateral keratoconus.  Proving that epithelial changes could detect early KC with normal posterior elevation measurements.

The diagnosis of early keratoconus can be based on suggestive epithelial mapping with normal elevation maps

The study included 17 eyes of 15 patients with moderate to advanced keratoconus in one eye but a clinically and algorithmically topographically normal fellow eye. MS39 AS-OCT epithelial thickness data were acquired and a previously developed classification model was applied for identification of keratoconus to the clinically normal fellow eyes. Pentacam (Oculus Optikgeräte, Germany) Belin-Ambrósio Display (BAD) data, providing the BFS and BAD posterior elevations measurements. Both of them were used to detect epithelial changes in patients with known unilateral keratoconus (KC) in the fellow eye.

All of the 17 patients have an epithelial thinning over the steep area with the epithelial donut formation at the thinnest pachmetry with normal BFS and BAD posterior elevation measurements in all eyes, on the other hand, they have a compatible KC in the fellow eyes. So these eyes were classified as early keratoconic or forme fruste keratoconus by the AS-OCT MS39 epithelium model.

The diagnosis of early keratoconus can be based on suggestive epithelial mapping with normal elevation maps. This is accurately done by AS-OCT MS39, this may change the concept stating that the diagnosis of KC shouldn’t be built without abnormal posterior elevations. Also, epithelial mapping should be added to the enhanced ectasia screening modules as one of the important factors considered to rule out KC and ectasia susceptibility.