International Journal of Keratoconus and Ectatic Corneal Diseases

Register      Login

VOLUME 1 , ISSUE 3 ( September-December, 2012 ) > List of Articles

RESEARCH ARTICLE

Keratoconus associated with Corneal Guttata

Isaac C Ramos, Bruno F Valbon, Leonardo N Pimentel, Diogo L Caldas

Citation Information : Ramos IC, Valbon BF, Pimentel LN, Caldas DL. Keratoconus associated with Corneal Guttata. Int J Kerat Ect Cor Dis 2012; 1 (3):173-178.

DOI: 10.5005/jp-journals-10025-1033

Published Online: 01-08-2015

Copyright Statement:  Copyright © 2012; The Author(s).


Abstract

Purpose

To describe clinical findings of cases with keratoconus and concomitant corneal guttata.

Setting

Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Brazil.

Materials and methods

In a retrospective study including 138 patients with clinical keratoconus, 22 eyes from 11 (8%) patients with keratoconus were identified with the presence of corneal guttata. Complete ophthalmologic examination was performed in all patients, including Scheimpflug rotation tomography (Pentacam HR, Oculus, Wetzlar, Germany), biomechanical study associated with noncontact tonometry [ocular response analyzer (ORA); Reichert, Depew, USA], and specular microscopy (LSM 12000, Bio-Optics, Oregon, USA). The amount of guttata was correlated with biomechanical and tomographic parameters by nonparametric Spearman test.

Results

The mean age was 51.8 ± 20.9 (from 25 to 81) years, nine patients were female (81.9%). The mean of corrected distance visual acuity was 0.20 (20/32) ± 0.49 [from 0 (20/20) to 1.9 (10/800)] LogMar. Eleven eyes had corneal guttae grade I, six eyes grade II, four eyes grade III, and one eye grade IV. The average central keratometric readings were 44.45 ± 2.54 (from 39.70 to 50.60) for flattest K (K1), 46.08 ± 2.69 (from 42.40 to 53.50) for steepest K (K2) and 45.24 ± 2.52 (from 42.00 to 52.20) for average K (Km). Maximal keratometric value (Kmax) averaged 47.63 ± 3.10 (from 43.5 to 55.8) D. The mean CCT was 482.54 ± 52.13 µm (from 398 to 585) and in the thinnest point 474.45 ± 50.32 µm (from 387 to 577). The mean of pachymetric progression indices were 0.83 ± 0.41 (from 0.2 to 2.03) (PPI Min), 1.24 ± 0.53 (from 0.7 to 2.73) (PPI Avg), and 1.79 ± 0.92 (from 0.88 to 4.67) (PPI Max). The mean of ART Min was 710.54 ± 372.47 (from 190.64 to 1985), of ART Avg was 433.18 ± 140.96 (from 141.75 to 678.37), and of ART Max was 315.64 ± 122.69 (from 102.78 to 539.78). The mean of front and back elevation at the thinnest point (using best fit sphere to 8 mm) was 5.35 ± 6.77 (from −4 to 20) and 19.15 ± 16.41 (from 1 to 50) respectively. Belin-Ambrósio deviation index (BAD D) was 3.05 ± 3 (from −0.34 to 11.55). The mean corneal hysteresis (CH) was 8.23 ± 2.05 (from 4.1 to 10.9), corneal resistance factor (CRF) was 7.67 ± 2.4 (from 3.4 to 11.3). The amount of guttata was statistically correlated with Km and K1 (Spearman, p > 0.05).

Conclusion

Keratoconus and cornea guttata can coexist in the same patient. This association can camouflage corneal thinning and protrusion associated with ectasia, but elevation, relational thickness, along with combined tomographic indices and biomechanical properties are altered. The diagnosis should be considered in the complete ophthalmic examination, including corneal topography, and tomographic characterization, along specular documentation of corneal endothelium.

How to cite this article

Ramos IC, Belin MW, Valbon BF, Luz A, Pimentel LN, Caldas DL, Ambrósio R Jr. Keratoconus associated with Corneal Guttata. Int J Kerat Ect Cor Dis 2012;1(3):173-178.


PDF Share
  1. Keratoconus. Surv Ophthalmol 1998;42:297-319.
  2. Atopy and keratoconus: A multivariate analysis. Br J Ophthalmol 2000;84:834-36.
  3. Eye rubbing can cause keratoconus. Cornea 2004;23:539-40.
  4. Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol 1984;28:293-322.
  5. Corneal dystrophies and keratoconus. Curr Opin Ophthalmol 1996;7:71-82.
  6. Keratoconus associated with other corneal dystrophies. Cornea 2009;28: 127-35.
  7. Anterior keratoconus associated with unilateral cornea guttata. Cornea 2001;20: 881-84.
  8. Potential complications of ocular surgery in patients with coexistent keratoconus and Fuchs’ endothelial dystrophy. Ophthalmology 2006;113:2187-97.
  9. Keratoconus and Fuchs’ endothelial dystrophy. Cornea 1991;10:368.
  10. Fuchs’ corneal dystrophy. Expert Rev Ophthalmol 2010;5:147-59.
  11. Inheritance of a novel COL8A2 mutation defines a distinct early-onset subtype of fuchs corneal dystrophy. Invest Ophthalmol Vis Sci 2005;46: 1934-39.
  12. Inheritance of endothelial dystrophy of the cornea. Ophthalmologica 1980;181:301-13.
  13. Corneal endothelial dystrophy. A study of 64 families. Arch Ophthalmol 1978;96:2036-39.
  14. A specular microscopic study of families with endothelial dystrophy. Br J Ophthalmol 1981;65:396-400.
  15. Fuchs’ endothelial dystrophy of the cornea. Surv Ophthalmol 1993;38:149-68.
  16. Fuchs’ endothelial dystrophy of the cornea. 29th Sanford Gifford Memorial Lecture. Am J Ophthalmol 1974;78:363-83.
  17. Hereditary Fuchs’ Dystrophy. Am J Ophthalmol 1980;90:455-62.
  18. Endothelial mosaic in Fuchs’ dystrophy. A qualitative evaluation with the specular microscope. Arch Ophthalmol 1981;99:80-83.
  19. Novel pachymetric parameters based on corneal tomography for diagnosing keratoconus. J Refract Surg 2011;27:753-58.
  20. [Corneal thickness progression from the thinnest point to the limbus: Study based on a normal and a keratoconus population to create reference values]. Arq Bras Oftalmol 2006;69:579-83.
  21. Corneal- thickness spatial profile and corneal-volume distribution: Tomographic indices to detect keratoconus. J Cataract Refract Surg 2006;32:1851-59.
  22. An introduction to understanding elevation-based topography: How elevation data are displayed— a review. Clin Experiment Ophthalmol 2009;37:14-29.
  23. Evaluation of corneal shape and biomechanics before LASIK. Int Ophthalmol Clin 2011;51:11-38.
  24. Determining in vivo biomechanical properties of the cornea with an ocular response analyzer. J Cataract Refract Surg 2005;31:156-62.
  25. Survey of patients with granular, lattice, avellino and Reis-Bucklers corneal dystrophies for mutations in the BIGH3 and gelsolin genes. Arch Ophthalmol 2001;119:16-22.
  26. VSX1 mutation and corneal dystrophies. Ophthalmology 2005;112:170-71.
  27. Elucidating the molecular genetic basis of the corneal dystrophies: Are we there yet? Arch Ophthalmol 2007;125:177-86.
  28. The genetics of keratoconus. Ophthalmol Clin North Am 2003;16:607-20.
  29. Keratoconus: No association with the transforming growth factor beta-induced gene in a cohort of American patients. Cornea 2004;23:13-17.
  30. Central corneal thickness of Caucasians, Chinese, Hispanics, Filipinos, African Americans, and Japanese in a glaucoma clinic. Ophthalmology 2004;111:2211-19.
  31. Central corneal thickness in Northwestern American Indians/Alaskan Natives and comparison with White and African-American persons. Am J Ophthalmol 2008;146: 747-51.
  32. Corneal biomechanical metrics in eyes with refraction of −19.00 to +9.00 D in healthy Brazilian patients. J Refract Surg 2008;24:941-45.
  33. Imaging of the cornea: topography vs tomography. J Refract Surg 2010;26:847-49.
  34. Pentacam characterization of corneas with Fuchs dystrophy treated with Descemet membrane endothelial keratoplasty. J Refract Surg 2010;26:972-79.
  35. Quantitative analysis of endothelial mosaic pattern changes in anterior keratoconus. Am J Ophthalmol 1984;98:43-49.
  36. The human corneal endothelium in keratoconus: A specular microscopic study. Arch Ophthalmol 1979;97:1867-69.
  37. Corneal thickness- and age-related biomechanical properties of the cornea measured with the ocular response analyzer. Invest Ophthalmol Vis Sci 2006;47:5337-47.
  38. Ocular response analyzer measurements in keratoconus with normal central corneal thickness compared with matched normal control eyes. J Refract Surg 2011;27:209-15.
  39. Biomechanical properties of the cornea in Fuchs’ corneal dystrophy. Invest Ophthalmol Vis Sci 2009;50:3199-202.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.