Fernando Fuentes Bonthoux

University of Buenos Aires

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Timo‐Kolja Pförtner

University of Cologne

Jeremías G. Galletti

Consejo Nacional de Investigaciones Científicas y Técnicas

Marianella Delrivo

Hospital de Clínicas "José de San Martín"

Pablo Raul Ruisenor Vazquez

Experimental Medicine and Biology Institute

Jonatán David Galletti

University of Buenos Aires

Natalia Ximena Mínguez

University of Buenos Aires

Pablo Chiaradía

Hospital de Clínicas "José de San Martín"

Adriana Tytiun

Hospital de Clínicas "José de San Martín"

Enrique L. Nebot

University of Buenos Aires

Pablo Ruisenor Vazquez

University of Buenos Aires

Cooperative Institutions

University of Buenos Aires

Hospital de Clínicas "José de San Martín"

Experimental Medicine and Biology Institute

Instituto de la Visión

Consejo Nacional de Investigaciones Científicas y Técnicas

Academia Nacional de Medicina

Baylor College of Medicine

Ocular Surface Center

Academy of Medicine

Czech Academy of Sciences, Institute of Experimental Medicine

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Corneal Asymmetry Analysis by Pentacam Scheimpflug Tomography for Keratoconus Diagnosis

Journal of Refractive Surgery (2015)

Jonatán David Galletti Pablo Raul Ruisenor Vazquez Natalia Ximena Mínguez Marianella Delrivo Fernando Fuentes Bonthoux

PURPOSE: To evaluate intereye corneal asymmetry in Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) indices as a diagnostic method between normal patients and patients with keratoconus. METHODS: A retrospective, observational case series of 177 healthy, 44 indeterminate, and 121 patients with keratoconus classified by Pentacam ectasia detection indices, randomized to analysis and validation datasets. Intereye asymmetry in 20 Scheimpflug tomography corneal descriptors was calculated and compared to develop diagnostic models. RESULTS: Intereye asymmetry was not correlated with anisometropia in healthy controls but was correlated with the ectasia grade of the worse eye in patients with keratoconus. Patients with keratoconus had significantly greater intereye asymmetry in all descriptors except for relational thickness indices. Intereye asymmetry in front elevation at the thinnest corneal location afforded the single highest diagnostic performance (71% sensitivity and 85% specificity), whereas the best multivariate model combining intereye asymmetry in anterior and posterior keratometry, corneal thickness, and front and back elevation at the thinnest point provided 65% sensitivity and 97% specificity. Multivariate models upheld their performance in the validation dataset. Most (more than 90%) indeterminate patients, according to conventional Pentacam analysis, showed within-normal-range corneal asymmetry. CONCLUSIONS: Healthy corneas are markedly symmetric irrespective of anisometropia, but corneal asymmetry analysis does not provide sufficient sensitivity to be used alone for detecting keratoconus. However, its remarkable specificity suggests that it could be used combined with conventional single cornea Pentacam analysis to reduce the false-positive rate or in dubious cases. [ J Refract Surg . 2015;31(2):116–123.]

Scheimpflug principle

Ectasia

Corneal pachymetry

10.3928/1081597x-20150122-07

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Citations (29)

Keratoconus detection by corneal asymmetry analysis with Pentacam Scheimpflug tomography

Investigative Ophthalmology & Visual Science (2014)

Jonatán David Galletti Pablo Raul Ruisenor Vazquez Natalia Ximena Mínguez Marianella Delrivo Fernando Fuentes Bonthoux

Scheimpflug principle

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Comparative Diagnostic Performance of Pentacam Scheimpflug Tomography and Ocular Response Analyzer Measurements for Subclinical Keratoconus

Investigative Ophthalmology & Visual Science (2012)

Marianella Delrivo Jonatán David Galletti Fernando Fuentes Bonthoux Timo‐Kolja Pförtner Jeremías G. Galletti

Scheimpflug principle

Subclinical infection

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Anterior Corneal Surface Descriptors, Posterior Elevation and Pachymetric Progression in Normal and Subclinical Keratoconus as Assessed by Pentacam

Investigative Ophthalmology & Visual Science (2012)

Jonatán David Galletti Marianella Delrivo Fernando Fuentes Bonthoux Timo‐Kolja Pförtner Jeremías G. Galletti

Subclinical infection

Elevation (ballistics)

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Corneal Power Is Correlated with Anterior Chamber Diameter

Investigative Ophthalmology & Visual Science (2012)

Rafael Iribarren Fernando Fuentes Bonthoux Timo‐Kolja Pförtner Pablo Chiaradía William K. Stell

Purpose.: Although corneal power and axial length are known to be inversely correlated, the biological determinants of corneal power are unknown. To elucidate this correlation further, study authors investigated the relationships among corneal power, corneal diameter, anterior chamber diameter, and axial length in a sample of human adults. Methods.: The eyes of 61 subjects seen consecutively in an eye clinic were studied with a high-resolution optimal coherence tomography (OCT) pachymetry device and ophthalmic optical biometer. The relationships between corneal power, white-to-white (WTW) corneal diameter, anterior chamber diameter, and axial length were assessed with Pearson correlations. Results.: The mean age of the 61 subjects was 48.7 ± 19.4 years. Corneal power was negatively correlated with axial length (r = −0.303, P < 0.01); WTW corneal diameter (r = −0.399, P < 0.001); and most interestingly, anterior chamber diameter (r = −0.646, P < 0.001). There was also a positive correlation between anterior chamber diameter and axial length (r = 0.489, P < 0.001). Conclusions.: Greater anterior chamber diameters were associated with flatter corneas and, conversely, smaller anterior chamber diameters with steeper corneas. The growth patterns of the anterior segment may be determinants of corneal power.

Anterior chamber angle

Positive correlation

10.1167/iovs.11-8949

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Effects of Corneal Crosslinking for Keratoconus Assessed with Anterior Segment Optical Coherence Tomography

Cureus (2012)

Fernando Fuentes Bonthoux Jeremías G. Galletti Adriana Tytiun Pablo Chiaradía Timo‐Kolja Pförtner

Purpose: To report anterior segment optical coherence tomography (AS-OCT) findings in corneas of keratoconus patients treated with riboflavin-ultraviolet-A-light-induced crosslinking (CXL). Methods: Prospective, non-randomized, single-center clinical study that included 9 CXL-treated keratoconus eyes followed with corneal topography, specular microscopy and AS-OCT for 12 months. Results: Both reduction of keratometric values and corneal thinning were evidenced in CXL-treated eyes, whereas untreated fellow eyes showed topographic progression. Three structural changes were found with AS-OCT: increase of anterior (180 ± 20 μm) stroma reflectivity that peaked at six months; hyperreflective demarcation line in posterior stroma (365 ± 56 μm) that gradually reduced its intensity until becoming undetectable in 50% of the cases after 12 months; and incomplete secondary hyperreflective lines located at variable depths that gradually disappeared. Conclusions: AS-OCT is a useful tool for assessment of CXL results since it can detect quantitative and qualitative modifications induced by this treatment.

Ultraviolet a

10.7759/cureus.61

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Combining Ocular Response Analyzer Metrics for Corneal Biomechanical Diagnosis

Journal of Refractive Surgery (2013)

Pablo Raul Ruisenor Vazquez Marianella Delrivo Fernando Fuentes Bonthoux Timo‐Kolja Pförtner Jeremías G. Galletti

PURPOSE: To evaluate corneal biomechanical properties in non-keratoconic myopic eyes and to identify descriptors for improving the specificity of the Ocular Response Analyzer (ORA) (Reichert Ophthalmic Instruments, Depew, NY) testing for subclinical keratoconus detection. METHODS: Observational case series of 52 non-keratoconic non-myopic eyes and 97 non-keratoconic myopic eyes (spherical equivalent ⩽ −5 diopters [D]) in dataset 1 and 87 non-keratoconic eyes and 73 eyes with subclinical keratoconus in dataset 2. Examination included corneal topography, tomography, and biomechanical testing with the ORA. Receiver operating characteristic curves and logistic regression were used to identify optimal combinations of biomechanical indices for keratoconus detection. Main outcome measures were corneal thickness-corrected hysteresis (DifCH) and resistance factor (DifCRF), the difference between these two (CH-CRF), and the diagnostic performance of their combinations. RESULTS: Compared to non-keratoconic non-myopic eyes, non-keratoconic myopic eyes with flat corneas (average corneal power < 44.0 D) had reduced DifCH (mean ± standard deviation, 0.11 ± 1.27 vs −0.79 ± 1.50, P < .01) and DifCRF (0.24 ± 1.16 vs −0.70 ± 1.59, P < .01) values, whereas non-keratoconic myopic eyes with steep corneas showed no difference. Keratoconic eyes exhibited lower DifCH and DifCRF values than non-keratoconic myopic eyes. Combinations of DifCH, DifCRF, and CH-CRF had increased specificity (> 80%) for subclinical keratoconus compared to the DifCRF index alone (71%). CONCLUSIONS: In biomechanical keratoconus screening, some non-keratoconic myopic eyes show altered ocular biomechanical properties and are identified as false-positive cases. The low specificity of DifCRF when dealing with these non-keratoconic eyes could be improved by considering additional biomechanical descriptors such as DifCH and CH-CRF, which seem to be indicative of the aforementioned biomechanical profile. [ J Refract Surg. 2013;29(9):596–602.]

Subclinical infection

10.3928/1081597x-20130710-01

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Citations (17)

Multivariate Analysis of the Ocular Response Analyzer’s Corneal Deformation Response Curve for Early Keratoconus Detection

Journal of Ophthalmology (2015)

Jonatán David Galletti Pablo Raul Ruisenor Vazquez Fernando Fuentes Bonthoux Timo‐Kolja Pförtner Jeremías G. Galletti

Purpose . To thoroughly analyze corneal deformation responses curves obtained by Ocular Response Analyzer (ORA) testing in order to improve subclinical keratoconus detection. Methods . Observational case series of 87 control and 73 subclinical keratoconus eyes. Examination included corneal topography, tomography, and biomechanical testing with ORA. Factor analysis, logistic regression, and receiver operating characteristic curves were used to extract combinations of 45 corneal waveform descriptors. Main outcome measures were corneal-thickness-corrected corneal resistance factor (ccCRF), combinations of corneal descriptors, and their diagnostic performance. Results . Thirty-seven descriptors differed significantly in means between groups, and among them ccCRF afforded the highest individual diagnostic performance. Factor analysis identified first- and second-peak related descriptors as the most variable one. However, conventional biomechanical descriptors corneal resistance factor and hysteresis differed the most between control and keratoconic eyes. A combination of three factors including several corneal descriptors did not show better diagnostic performance than a combination of conventional indices. Conclusion . Multivariate analysis of ORA signals did not surpass simpler models in subclinical keratoconus detection, and there is considerable overlap between normal and ectatic eyes irrespective of the analysis model. Conventional biomechanical indices seem to already provide the best performance when appropriately considered.

Subclinical infection

Univariate

10.1155/2015/496382

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Citations (26)

Keratoconus Diagnostic Model Integrating Ocular Response Analyzer Measurements and Corneal Topography

Investigative Ophthalmology & Visual Science (2012)

Pablo Raul Ruisenor Vazquez Enrique L. Nebot Fernando Fuentes Bonthoux Marianella Delrivo Timo‐Kolja Pförtner

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Evaluation of the Diagnostic Performance of the Ocular Response Analyzer for Subclinical Keratoconus