Objectives: Early identification of keratoconus is imperative for preventing iatrogenic corneal ectasia and allowing for early corneal collagen cross-linking treatments to potentially halt progression and decrease transplant burden. However, early diagnosis of keratoconus is currently a diagnostic challenge as there is no uniform screening criteria. We performed a review of the current literature to assess imaging modalities that can be used to help identify subclinical keratoconus.
Methods: A Pubmed database search was conducted. We included primary and empirical studies for evaluating different modalities of screening for subclinical keratoconus.
Results: A combination of multiple imaging tools, including corneal topography, tomography, Scheimpflug imaging, anterior segment optical coherence tomography, and in vivo confocal microscopy will allow for enhanced determination of subclinical keratoconus. In patients who are diagnostically borderline using a single screening criteria, use of additional imaging techniques can assist in diagnosis. Modalities that show promise but need further research include polarization-sensitive optical coherence tomography, Brillouin microscopy, and atomic force microscopy.
Conclusions: Recognition of early keratoconus can reduce risk of post-refractive ectasia and reduce transplantation burden. Though there are no current uniform screening criterion, multiple imaging modalities have shown promise in assisting with the early detection of keratoconus.
摘要: 目的: 早期发现圆锥角膜对预防医源性角膜扩张以及实施早期角膜胶原交联治疗避免其潜在进展和减少移植负担十分必要。然而, 由于没有统一的筛查标准, 当前圆锥角膜的早期诊断具有挑战性。我们对现有的文献进行了回顾分析, 以评估有助于识别亚临床圆锥角膜的影像学手段。方法: 我们检索了Pubmed数据库, 纳入评估亚临床圆锥角膜不同筛查方式的初步及试验研究。结果: 多摸式影像学检查手段: 角膜地形图、断层扫描、Scheimpflug成像、眼前节光学相干断层扫描和活体共焦显微镜等可提高亚临床圆锥角膜的检测率。对于在单一筛选标准临界值的患者中, 使用额外的成像技术有助于诊断。有临床应用前景但需要进一步研究的方法包括偏振敏感光学相干断层扫描、brillouin显微镜和原子力显微镜。结论: 识别早期圆锥角膜可以减少屈光后扩张的风险及移植负担。尽管目前没有统一的筛查标准, 但多种影像学手段已显示出圆锥角膜早期发现的前景。.