CONCOMITANT KERATOCONUS AND FUCHS DYSTROPHY: TWO DISEASES IS BETTER THAN JUST ONE?

1. CONCOMITANT KERATOCONUS AND FUCHS DYSTROPHY: TWO DISEASES IS BETTER THAN JUST ONE? Isaac C. Ramos, Isabela Delpizzo, Bruno de F. Valbon, Leonardo N. Pimentel, Diogo L. Caldas, Ana Laura C. Canedo, Renato Ambrósio Jr. Dr. Ambrósio is consultant for Oculus Optikgeräte GmbH (Wetzlar, Germany)

2. Introduction • While thinning is a hallmark of ectatic diseases, thickening is the consequence of endothelial failure. Thereby, keratoconus and Fuchs Dystrophy may “neutralize” each other in the pathophysiologic process. Corneal Thickness Corneal Thickness Corneal Thickness Keratoconus Corneal Guttata Keratoconus + Corneal Guttata

3. Purpose • To compare the visual performance, along with tomographic and biomechanical findings among cases with keratoconus and cases with concomitant keratoconus and corneal guttata.

4. Methods • Visual performance, along with tomographic and biomechanical findings were compared among 21 eyes from 21 patients with Keratoconus (group 1) and 22 eyes from eleven patients with concomitant keratoconus and corneal guttata (group 2). • The non-parametric Wilcoxon–Mann–Whitney test was used to assess different distributions among paired groups.

5. Methods • Twenty-two eyes from eleven patients with concomitant keratoconus and corneal guttata (group 2) were confirmed by clinical examination, specular microscopy and Scheimpflug based corneal tomo-graphy. Non contact tonometry and biomechanical analysis was also performed with ORA. Camel’s second hum sign

6. Results • There was a statistically lower K2, keratometric astigmatism and pachymetric progression indices (min, ave and max) in the keratoconus and guttata group compared to the group with keratoconus (Wilcoxon-Mann-Whitney test, p<0.05). K2 ∆k P = 0.0491 P = 0.0026 K K+G K K+G

7. Results • There was a statistically lower K2, keratometric astigmatism and pachymetric progression indices (min, ave and max) in the keratoconus and guttata group compared to the group with keratoconus (Wilcoxon-Mann-Whitney test, p<0.05). PPI Min PPI Avg PPI Max P = 0.04 P = 0.0012 P = 0.0022 K K+G K K+G K K+G

8. Results Example case with keratoconus in OD (normal endothelium) and relatively normal tomography in the left eye with endothelial changes on specular microscopy. OD OS Sagital Map Elevation Back Map Sagital Map Elevation Back Map

9. Results • There was no statistically difference in CRF and CH • (p = 0,9516; p = 0,7986) between groups 1 and 2. Signal Time Response Signal Time Response Keratoconus Keratoconus + Corneal Guttata

10. Results • The group with keratoconus and corneal guttata showed statistically better CDVA (Corrected Distance Visual Acuity) than keratoconus group. (Wilcoxon-Mann-Whitney test, p<0.05) CDVA (LogMAR) P = 0.0047 K K+G

11. Conclusions • The concomitance of keratoconus and endothelial disease seems to reduce the severity of ectasia which is observed on  corneal tomo-graphy, but it does not affect biomechanical measurements. • The visual performance on the group with concomitant keratoconus and corneal guttata was better than the group with keratoconus.