Dutra Barbara A L, Hammoud Bassel, Susanna Bianca N, Asroui Lara, Scarcelli Giuliano, Dupps William J, Randleman J Bradley
From the Cleveland Clinic (B.A.D., B.H., B.N.S., L.A., W.J.D., J.B.R.), Cole Eye Institute, Cleveland, Ohio, USA; Department of Ophthalmology (B.A.D., B.N.S.), University of Sao Paulo, Sao Paulo, Brazil.
From the Cleveland Clinic (B.A.D., B.H., B.N.S., L.A., W.J.D., J.B.R.), Cole Eye Institute, Cleveland, Ohio, USA.
Am J Ophthalmol. 2025 Jun;274:209-220. doi: 10.1016/j.ajo.2025.02.042. Epub 2025 Mar 6.
To evaluate the utility of automated epithelial thickness metrics to identify subclinical keratoconus (SKC) through epithelial thickness pattern comparisons between normal controls, (SKC), and manifest keratoconus (KC).
Retrospective cross-sectional study.
There were 200 eyes from 200 patients evaluated, including: (1) 100 control eyes from 100 patients with bilaterally normal corneal topography/tomography and slit-lamp examination (controls); (2) 50 eyes from 50 patients with SKC; (3) 50 eyes from 50 patients with KC. Epithelial mapping was performed using anterior segment optical coherence tomography (AS-OCT) imaging (Avanti RTVue XR, Optovue). Area under the receiver operating characteristic (AUROC) curves were used to determine the overall discriminative accuracy of the significant test parameters as described by the area under the curve (AUC) and to calculate the sensitivity and specificity of each parameter.
There were no differences between control and SKC groups in any regional OCT epithelial thickness parameter. Among relational epithelial thickness metrics, only superonasal - inferotemporal (SN-IT) value differences reached statistical significance between control and SKC groups (-0.81 μm versus 0.41 μm), but this metric still showed limited performance in differentiating groups (AUROC = 0.68). Most stromal thickness values were significantly different between SKC and controls.
Epithelial thickness patterns were not effective as a primary metric to identify subclinical keratoconus. Scheimpflug metrics and regional stromal thickness values significantly outperformed epithelial metrics in differentiating both SKC and KC eyes from controls. Epithelial mapping metrics thus appear significantly less sensitive than predicted for subclinical keratoconus detection in early disease manifestations.
通过比较正常对照组、亚临床圆锥角膜（SKC）和圆锥角膜（KC）患者的上皮厚度模式，评估自动上皮厚度指标在识别亚临床圆锥角膜中的作用。
回顾性横断面研究。
对200例患者的200只眼睛进行评估，包括：（1）100例双侧角膜地形图/断层扫描及裂隙灯检查均正常的患者的100只对照眼（对照组）；（2）50例SKC患者的50只眼睛；（3）50例KC患者的50只眼睛。使用眼前节光学相干断层扫描（AS-OCT）成像（Avanti RTVue XR，Optovue）进行上皮层测绘。采用受试者操作特征（AUROC）曲线下面积来确定显著测试参数的总体判别准确性，如曲线下面积（AUC）所述，并计算每个参数的敏感性和特异性。
对照组和SKC组在任何区域OCT上皮厚度参数上均无差异。在相关上皮厚度指标中，仅鼻上-颞下（SN-IT）值差异在对照组和SKC组之间达到统计学意义（-0.81μm对0.41μm），但该指标在区分两组时性能仍有限（AUROC = 0.68）。SKC组和对照组之间的大多数基质厚度值存在显著差异。
上皮厚度模式作为识别亚临床圆锥角膜的主要指标无效。在区分SKC和KC患眼与对照眼方面，Scheimpflug指标和区域基质厚度值明显优于上皮指标。因此，上皮层测绘指标在亚临床圆锥角膜早期疾病表现检测中的敏感性明显低于预期。
