Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, India.
Director, Cornea, Cataract and Refractive Surgery Services, Aditya Jyot Eye Hospital, Mumbai, India.
Indian J Ophthalmol. 2020 Dec;68(12):2819-2830. doi: 10.4103/ijo.IJO_2399_20.
One of the leading challenges in refractive surgery today is the presence of underlying subclinical early-stage keratoconus (KC), which can lead to iatrogenic post laser in situ keratomileusis ectasia. Timely detection of this condition could aid the refractive surgeons in better decision-making. This includes being able to defer refractive surgery in subclinical cases as well as providing treatment for the same in the form of appropriate corneal collagen crosslinking treatments. Corneal topography is considered the gold standard for the diagnosis of corneal ectatic disorders. However, there is a likelihood that topographers are overlooking certain subclinical cases. The corneal epithelium is known to remodel, which may mask underlying stromal irregularities. Imaging and analyzing corneal epithelium and stroma independently will undoubtedly open newer avenues to supplement our understanding of postrefractive surgery outcomes and KC. This review encapsulates the various Optical coherence tomography-based epithelial mapping devices particularly RTVue (Optovue, Fremont, USA) and MS-39 (Costruzione Strumenti Oftalmici, Florence, Italy) in terms of their utility in these conditions. It will help guide the clinician on how including an epithelial mapping in clinical practice can aid in diagnosis, management, and interpretation of outcomes both for refractive surgery as well as KC.
当今屈光手术面临的主要挑战之一是存在潜在的亚临床早期圆锥角膜（KC），这可能导致激光原位角膜磨镶术后医源性扩张。及时发现这种情况可以帮助屈光外科医生做出更好的决策。这包括能够在亚临床病例中推迟屈光手术，并以适当的角膜胶原交联治疗形式为该疾病提供治疗。角膜地形图被认为是诊断角膜扩张性疾病的金标准。然而，存在一种可能性，即地形图可能忽略了某些亚临床病例。已知角膜上皮会重塑，这可能会掩盖潜在的基质不规则性。独立地对角膜上皮和基质进行成像和分析无疑将开辟新的途径，以补充我们对屈光手术后结果和 KC 的理解。这篇综述总结了各种基于光学相干断层扫描的上皮测绘设备，特别是 RTVue（Optovue，美国弗里蒙特）和 MS-39（Costruzione Strumenti Oftalmici，意大利佛罗伦萨），就其在这些情况下的实用性而言。它将帮助临床医生了解如何在临床实践中加入上皮测绘，以帮助诊断、管理和解释屈光手术以及 KC 的结果。
