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Galilei™ for Keratoconus Diagnosis

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Keratoconus
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Abstract

Keratoectasias are a group of corneal deformations that have ectasia as the most recognized and fundamental clinical sign in topography, tomography, and pachymetry. The Galilei™ allows the recognition and diagnosis of primary keratoectasias like keratoconus, pellucid marginal degeneration, and keratoglobus, and of the postoperative acquired secondary keratoectasia that may happen after laser refractive surgery, corneal graft transplantation, or radial keratotomy. Corneal ectasia is defined as a chronic time-dependent progressive abnormal protrusion forward identified on either of its two surfaces and caused by a biomechanical failure of the tissue.

Keratoconus is the best-known and more prevalent primary keratoectasia worldwide. There is no keratoconus without ectasia, but both terms are not synonyms. Other signs of keratoconus like steepening, asymmetry, and/or thinning may be presented separately or together with or without ectasia. This chapter teaches how to identify and quantify with the Galilei™ each of these signs and shows six basic types of corneas with pre-keratoconus stages without ectasia. There is a short description of corneas with asymmetry but without steepening or ectasia, corneas with steeper astigmatism but without asymmetry or ectasia, and thin corneas without steepening or ectasia. Examples of posterior keratoconus are presented, and extreme peripheral flattening is incorporated as a new sign in keratoconus. Forme-frustre keratoconus is also depicted using the CLMI.X report, which is unique in the Galilei™. In conclusion, the Galilei™ integrates the data from dual Placido topography and dual Scheimpflug tomography, facilitating the interpretation of maps by color-coding the scales for each measured parameter and recognizing the different types of corneal deformation even before ectasia happens.

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References

  1. Arce CG, Trattler W. Keratoconus and keratoectasia. In: Boyd S, Gutiérrez AM, McCulley JP, editors. Atlas and text of corneal pathology and surgery. Panama: Jaypee Highlights Medical Publishers; 2010, pp. 161–225.

    Google Scholar 

  2. Arce CG, Srinivasan S. Astigmatismo anterior, posterior y total da córnea. Estrategia para mejorar el alineamiento de LIOs tóricas. Rosario: First Iberoamerican Congress of Ophthalmology; 2013.

    Google Scholar 

  3. Alfonso JF, Lisa C, Merayo-Lloves J, Fernández-Veja-Cueto L, Montés-Micó R. Intrastromal corneal ring segment implantation in paracentral keratoconus with coincident topographic and coma axis. J Cataract Refract Surg. 2012;38(9):1576–82. https://doi.org/10.1016/j.jcrs.2012.05.031.

    Article  PubMed  Google Scholar 

  4. Rabinowitz YS, Yang H, Brickman Y, Akkina J, Riley C, Rotter JI, Elashoff J. Videokeratography database of normal human corneas. Br J Ophthalmol. 1996;80:610–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Sinjab MM, Youssef LN. Pellucid-like keratoconus. F1000 Research. 2012;1:48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752625/.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Perry HD, Buxton JN, Fine BS. Round and oval cones in keratoconus. Ophthalmology. 1980;87(9):905–9. https://doi.org/10.1016/S0161-6420(80)35145-2.

    Article  CAS  PubMed  Google Scholar 

  7. Seiler T, Quurke AW. Iatrogenic keratectasia after LASIK in a case of forme fruste keratoconus. J Cataract Refract Surg. 1998;24:1007–9.

    Article  CAS  PubMed  Google Scholar 

  8. Arce CG, Dias JL, Campos MS, Schor P. Modulation of progressive postoperative corneal ectasia. Paper presented at the American Society of Cataract and Refractive Surgery (ASCRS) meeting; Chicago; 4–9 Apr 2008.

    Google Scholar 

  9. Arce CG, Lacayo III GO, Waring IV GO. Complex case management: refractive enhancement 10 years later? Cataract Refract Today, Nov 2011. https://crstoday.com/articles/2011-nov/complex-case-management-refractive-enhancement-10-years-later/.

  10. Abelson MB, Collin HB, Gillette TE, Dohlman CH. Recurrent keratoconus after keratoplasty. Am J Ophthalmol. 1980;90:672–6. https://doi.org/10.1016/s0002-9394(14)75135-75139.

    Article  CAS  PubMed  Google Scholar 

  11. Deitz MR, Sanders DR, Raanan MG. Progressive hyperopia in radial keratotomy. Long-term follow-up of diamond-knife and metal-blade series. Ophthalmology. 1986;93(10):1284–90.

    Article  CAS  PubMed  Google Scholar 

  12. Arce CG. Diagnóstico de queratocono con tomografía de duplo Scheimpflug y topografía de Plácido. In: Albertazzi R, editor. Queratocono. 2nd edition. Buenos Aires: Consejo Argentino de Oftalmologia; 2021, pp. 63–102.

    Google Scholar 

  13. Larco S, Ayala A, Untuna M, Arce CG. Diagnosis of the month. PRK in corneas with steeper symmetric high astigmatism. CRST-Europe. 2014;9(8):46–7.

    Google Scholar 

  14. Mahmoud AM, Nunez MX, Blanco C, Koch DD, Wang L, Weikert MP, Frueh BE, Tappeiner C, Twa MD, Roberts CJ. Expanding the cone location and magnitude index to include corneal thickness and posterior surface information for the detection of keratoconus. Am J Ophthalmol. 2013;156:1102–11.

    Article  PubMed  Google Scholar 

  15. Rabinowitz YS. Videokeratographic indices to aid in screening for keratoconus. J Refract Surg. 1995;11:371–9.

    Article  CAS  PubMed  Google Scholar 

  16. Rabinowitz YS, Rasheed K. KISA% index: a quantitative videokeratography algorithm embodying minimal topographic criteria for diagnosing keratoconus. J Cataract Refract Surg. 1999;25:1327–35.

    Article  CAS  PubMed  Google Scholar 

  17. Yildiz BK, Atik BK, Yildirim Y, Agca A, Yasa D, Besek NK, Aygit ED, Demirok A. Laser in situ keratomileusis (LASİK) in patients with superior steepening on corneal topography: is it safe and predictable? Int Ophthalmol. 2020;40:2353–9. https://doi.org/10.1007/s10792-020-01420-6.

    Article  Google Scholar 

  18. Kim T, Khosla-Gupta B, Debacker C. Blepharoptosis-induced superior keratoconus. Am J Ophthalmol. 2000;130(2):232–4.

    Article  CAS  PubMed  Google Scholar 

  19. Arce CG, Forseto ADS, Pfluck H, Bocchese L, Pedral L, Pereira NC. Presentation patterns of peripheral anterior and posterior curvature maps in normal corneas and corneas with keratoconus. Presented at the European Society of Cataract and Refractive Surgeons (ESCRS) Congress; Copenhagen; 10–14 Sep 2016.

    Google Scholar 

  20. Amsler M. The “forme fruste” of keratoconus. Wien Klin Wochenschrift. 1961;73:842–3.

    CAS  Google Scholar 

  21. Klyce SD. Controversies in ophthalmology. Presented at the Eye Bank Association of America Annual Meeting; Hollywood; 7 Jun 2008.

    Google Scholar 

  22. Studer H. Accurate anterior segment topography. In: Galilei G4 and G6 key features. Port: Ziemer Ophthalmic Systems AG. https://e-learning.ziemergroup.com.

  23. Núñez XM, Blanco-Marín C. Tomographic detection of keratoconus suspects. Presented at the American Society of Cataract and Refractive Surgeons (ASCRS) Meeting; San Francisco; 19–23 Apr 2013.

    Google Scholar 

  24. Arce CG. Kerarings. Presented at the 2nd Red Sea Ophthalmology Symposium (RSOS), Jeddah; 14–16 Jan 2016.

    Google Scholar 

  25. Arce CG. Custom crosslinking guided by Galilei curvature maps. Presented at the 47th National Congress of the Ophthalmological Society of South Africa (OSSA), Port Elizabeth; 15–19 Mar 2017.

    Google Scholar 

  26. Arce CG, Forseto ADS, Pfluck H, Bocchese L, Pedral Sampaio L, Pereira NC. Big bubble type 1 formation during DALK guided by dual Scheimpflug and 10-mm-diameter Plácido topography and pachymetry maps. Presented at the American Society of Cataract and Refractive Surgeons (ASCRS) Meeting; Washington, DC; 13–17 Apr 2018.

    Google Scholar 

  27. Bayraktar Bilen N, Hepsen IF, Arce CG. Correlation between visual function and refractive, topographic, pachymetric and aberrometric data in eyes with keratoconus. Int J Ophthalmol. 2016;9:1127–33.

    PubMed  PubMed Central  Google Scholar 

  28. Arce CG. Galilei™: topografía de Plácido y tomografía del segmento anterior con doble Scheimpflug. In: Castillo A, editor. Métodos diagnósticos en segmento anterior (Monografías SECOIR), Sección 2, Evaluación preoperatoria. Madrid: SECOIR; 2011, pp. 211–36.

    Google Scholar 

  29. Arce CG. Galilei: topografia de Plácido e tomografia do segmento anterior com duplo Scheimpflug. In: Ambrósio R Jr, Chalita MR, Vieira Netto M, Schor P, Chamon W, Fontes BM, editors. Wavefront & topografia, tomografia e biomecânica da córnea. 7th edition. Rio de Janeiro: Cultura Médica; 2013, pp. 165–202.

    Google Scholar 

  30. Arce CG. Corneal shape and HOAs may be used to distinguish corneas with keratoconus. Presented at the American Society of Cataract and Refractive Surgeons (ASCRS) Meeting; Boston; 9–14 Apr 2010.

    Google Scholar 

  31. Arce CG. Corneal shape and HOAs may be used to distinguish corneas with keratoconus. Presented at the European Society of Cataract and Refractive Surgeons (ESCRS) Congress; Paris; 4–8 Sep 2010.

    Google Scholar 

  32. Belin MW, Khachikian SS, Ambrósio R Jr, Salomão M. Keratoconus/ectasia detection with the Oculus Pentacam: Belin/Ambrósio enhanced ectasia display. Highlights Ophthalmol. 2007;35(6):5–12. https://www.pentacam.com/fileadmin/user_upload/pentacam.de/downloads/publikationen/sonderdrucke/2008-Article_Supplement_Pentacam_Belin_Ambrosio_Enhaced_Ectasia_Display.pdf.

  33. Gomes JA, Tan D, Rapuano CJ, et al. Group of Panelists for the Global Delphi Panel of Keratoconus and Ectatic Diseases. Global consensus on keratoconus and ectatic diseases. Cornea. 2015;34:359–69.

    Google Scholar 

  34. Arce CG, Campos M, Schor P. Overlooked features of corneal topographers. J Cataract Refract Surg. 2008;34:719–20.

    Article  PubMed  Google Scholar 

  35. Maeda N, Klyce SD, Smolek MK, Thompson HW. Automated keratoconus screening with corneal topography analysis. Invest Ophthalmol Vis Sci. 1994;35(6):2749–57.

    CAS  PubMed  Google Scholar 

  36. Mahmoud AM, Roberts C, Lembach R, Herderick EE, McMahon TT, Clek Study Group. Simulation of machine-specific topographic indices for use across platforms. Optom Vis Sci. 2006;83:682–93.

    Article  PubMed  Google Scholar 

  37. Roberts CJ. KPI Analysis with the Galilei™. Galilei technical bulletin No. 4. Port: Ziemer Ophthalmic Systems AG; 2010.

    Google Scholar 

  38. Guldimann B. Release notes—SW 6.0. Port: Ziemer Ophthalmic Systems AG; 2012.

    Google Scholar 

  39. Núñez MX, Blanco C. Comparison between CLMI and KPI. Presented at the American Academy of Ophthalmology (AAO) Meeting; Chicago; 10–13 Nov 2012.

    Google Scholar 

  40. Ramani V, Azari Z, Arce CG, Nilamiham P. Analysis of keratoconus detection and progression using keratoconus prediction index and anterior axial cone location & magnitude index. Unpublished paper, 2013.

    Google Scholar 

  41. Ramani V. Wrap-up on keratoconus detection using the Galilei dual Scheimpflug analyzer. In: The most discriminant Galilei indices for keratoconus detection. Port: Ziemer Ophthalmic Systems AG. 2013. https://e-learning.ziemergroup.com.

  42. Reddy JC, Rapuano CJ, Cater JR, Suri K, Nagra PK, Hammersmith KM. Comparative evaluation of dual Scheimpflug imaging parameters in keratoconus, early keratoconus, and normal eyes. J Cataract Refract Surg. 2014;40(4):582–92.

    Article  PubMed  Google Scholar 

  43. Feizi S, Yaseri M, Kheiri B. Predictive ability of Galilei to distinguish subclinical keratoconus and keratoconus from normal corneas. J Ophthalmic Vis Res. 2016;11(1):8–16. https://doi.org/10.4103/2008-322X.180707.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Shetty R, Rao H, Khamar P, Sainani K, Vunnava K, Jayadev C, Kaweri L. Keratoconus screening indices and their diagnostic ability to distinguish normal from ectatic corneas. Am J Ophthalmol. 2017;181:140–8.

    Article  PubMed  Google Scholar 

  45. Lewis JR, Frueh BE, Tappeiner C, Mahmoud AM, Roberts CJ. Keratoconus screening based on broader applications of CLMI algorithm. Invest Ophthalmol Vis Sci. 2011;52(14):5167.

    Google Scholar 

  46. Smadja D, Santhiago MR, Mello GR, Krueger RR, Colin J, Touboul D. Influence of the reference surface shape for discriminating between normal corneas, subclinical keratoconus, and keratoconus. J Refract Surg. 2013;29:274–81.

    Article  PubMed  Google Scholar 

  47. Smadja D, Touboul D, Cohen A, Doveh E, Santhiago MR, Mello RM, Krueger RR, Colim J. Detection of subclinical keratoconus using an automated decision tree classification. Am J Ophthalmol. 2013;156:237–46.

    Article  PubMed  Google Scholar 

  48. Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol. 2011;95:335–9. https://doi.org/10.1136/bjo.2009.174284.

    Article  PubMed  Google Scholar 

  49. Izquierdo L, Sossa D, Ben-Shaul O, Henriquez MA. Corneal lenticule extraction assisted by a low-energy femtosecond laser. J Cat Refract Surg. 2020;46(9):1217–21. https://doi.org/10.1097/j.jcrs.0000000000000236.

    Article  Google Scholar 

  50. Schor P, Arce CG. Aspectos básicos do Orbscan. In: Alves MR, Chamon W, Nosé W, editors. Cirurgia refrativa. Brazilian Council of Ophthamology. Rio de Janeiro: Cultura Médica; 2003, pp. 21–49.

    Google Scholar 

  51. Arce CG, Francesconi CM. Topografia da córnea por varredura de fenda de luz—Orbscan I, II e IIZ. In: Ruiz-Alves M, Campos M, Ambrosio Jr R, Chamon W, CHR D, editors. Cirurgia refrativa. Serie Oftalmológica Brasileira. 3rd edition. Rio de Janeiro: Cultura Médica; 2013, pp. 71–86.

    Google Scholar 

  52. Arce CG. A paquimetria óptica como ajuda diagnóstica do ceratocone e outras patologias. Arq Bras Oftalmol. 2009;72(Suppl):33. http://www.abonet.com.br/abo/724s/31-74.pdf.

  53. Santhiago MR, Smadja D, Gomes BF, Mello GR, Monteiro ML, Wilson SE, Randleman JB. Association between the percent tissue altered and post-laser in situ keratomileusis ectasia in eyes with normal preoperative topography. Am J Ophthalmol. 2014;158(1):87–95.

    Article  PubMed  Google Scholar 

  54. Alzamora JB, Maidana EJ, Arce CG, Schor P, Campos MSQ. Spatial variation of normal corneal thickness assessed by Orbscan II. Presented at the World Ophthalmology Congress; São Paulo; 19–24 Feb 2006.

    Google Scholar 

  55. Ambrósio R, Alonso RS, Luz A, Coca Velarde LG. Corneal-thickness spatial profile and corneal-volume distribution: tomographic indices to detect keratoconus. J Cataract Refract Surg. 2006;32:1851–9.

    Article  PubMed  Google Scholar 

  56. Arce CG. Galilei map interpretation guide: SW 5.0 Ziemer booklet. Port: Ziemer Ophthalmic Systems AG; 2012.

    Google Scholar 

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Arce, C.G. (2022). Galilei™ for Keratoconus Diagnosis. In: Almodin, E., Nassaralla, B.A., Sandes, J. (eds) Keratoconus . Springer, Cham. https://doi.org/10.1007/978-3-030-85361-7_10

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  • DOI: https://doi.org/10.1007/978-3-030-85361-7_10

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