The Role Of Epithelial Mapping In The Differential Diagnosis Of Keratoconus
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR372 | Type: Free paper | DOI: 10.82333/j1nc-vw97
Authors: Dr Komila Mubarakova 1 , Diyora Abduvalieva* 2 , Dr Shavkat Mukhanov 1
1Ophthalmology,SIHAT KOZ,Tashkent,Uzbekistan, 2Ophthalmology,Tashkent State Medical University,Tashkent,Uzbekistan
Purpose
To determine the diagnostic significance of anterior segment optical coherence tomography (OCT) epithelial map parameters in the differential diagnosis of dry eye syndrome and various stages of keratoconus.
Setting
The study was conducted from 2024 to 2026 at the “SIHAT KO`Z” Eye Clinic. A total of 450 patients were examined, including 256 men and 194 women. According to the clinical diagnosis, patients were divided into three groups:
group I – dry eye syndrome: 150 patients (300 eyes); group II – subclinical keratoconus: 130 patients (260 eyes); group III – stage I keratoconus: 170 patients (340 eyes).
Methods
All patients underwent anterior segment OCT of the cornea with epithelial thickness analysis (minimum and maximum values, inferior–superior asymmetry (ISA)) and measurement of the thinnest corneal point. The examinations were performed using the Optovue Solix diagnostic system (USA).
Results
Dry eye syndrome: the minimum epithelial thickness was 50.3±0.4 µm, the maximum was 52.6±0.4 µm, ISA = 1.45±0.05 D, and the thinnest corneal thickness was 506.3±3.4 µm. Subclinical keratoconus: the minimum epithelial thickness was 47.2±0.6 µm, the maximum was 63.1±0.5 µm, ISA = 1.62±0.05 D, and the thinnest corneal thickness was 492.4±3.2 µm. Stage I keratoconus: the minimum epithelial thickness was 38.2±0.6 µm, the maximum was 70.5±0.5 µm, ISA = 1.91±0.05 D, and the thinnest corneal thickness was 481.7±3.5 µm.
Conclusions
In dry eye syndrome, instability and irregularity of the tear film lead to diffuse variability in corneal epithelial thickness and its uneven distribution on the epithelial map. In subclinical keratoconus, the epithelial map demonstrates segmental epithelial thickening reflecting a compensatory response to localized stromal changes. In keratoconus, the epithelial map shows epithelial thinning over the cone apex within the ectatic zone, while paracentral areas demonstrate compensatory thickening. As a result, a characteristic epithelial “ring” forms around the ectatic zone. Anterior segment OCT with epithelial mapping enables differential diagnosis of dry eye syndrome, subclinical keratoconus, and manifest keratoconus.