PMID- 37531392
OWN - NLM
STAT- MEDLINE
DCOM- 20231106
LR  - 20231114
IS  - 1873-4502 (Electronic)
IS  - 0886-3350 (Linking)
VI  - 49
IP  - 11
DP  - 2023 Nov 1
TI  - New keratoconus staging system based on OCT.
PG  - 1098-1105
LID - 10.1097/j.jcrs.0000000000001276 [doi]
AB  - PURPOSE: To establish a numerical spectral-domain optical coherence tomography 
      (SD-OCT)-based keratoconus (KC) staging system and compare it with existing KC 
      staging systems. SETTING: Eye Hospital of Wenzhou Medical University, Wenzhou, 
      China. DESIGNS: Retrospective case-control study. METHODS: Scheimpflug 
      tomography, air-puff tonometry, and SD-OCT were performed on 236 normal and 331 
      KC eyes. All SD-OCT-derived parameters of the corneal epithelium and stroma were 
      evaluated based on their receiver operating characteristic (ROC) curves, area 
      under the curve (AUC), sensitivity, and specificity to discriminate between 
      normal and KC eyes. The best performing parameters were subsequently used to 
      create an OCT-based staging system, which was compared with existing tomographic 
      and biomechanical staging systems. RESULTS: 236 eyes from 236 normal patients and 
      331 eyes from 331 KC patients of different stages were included. The highest 
      ranked AUC ROC SD-OCT parameters, derived from stroma and epithelium, were stroma 
      overall minimum thickness (ST: AUC 0.836, sensitivity 90%, specificity 67%) and 
      epithelium overall SD (EP: AUC 0.835, sensitivity 75%, specificity 78%). A 
      numerical SD-OCT staging system called STEP including 2 parameters-"ST" and 
      "EP"-with 5 stages was proposed. CONCLUSIONS: The new SD-OCT-based KC staging 
      system is the first to take the epithelium with its sublayer stroma information 
      into account, showing a strong agreement to the existing staging systems. This 
      system could be incorporated into daily practice, potentially leading to an 
      overall improvement in KC treatment and follow-up management.
CI  - Copyright (c) 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on 
      behalf of ASCRS and ESCRS.
FAU - Lu, Nan-Ji
AU  - Lu NJ
AUID- ORCID: 0000-0003-3096-9579
AD  - From the Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, 
      Belgium (Lu, Koppen, Ni Dhubhghaill, Rozema); National Clinical Research Center 
      for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China 
      (Lu, Hafezi, Aslanides, Chen, Cui); State Key Laboratory of Ophthalmology, 
      Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 
      China (Lu, Chen, Cui); Department of Ophthalmology, West China Hospital, Sichuan 
      University, Chengdu, Sichuan, China (Lu, Wang); ELZA Institute, Dietikon, 
      Switzerland (Lu, Hafezi, Torres-Netto); Ocular Cell Biology Group, Center for 
      Applied Biotechnology and Molecular Medicine, University of Zurich, Switzerland 
      (Hafezi, Torres-Netto); Faculty of Medicine, University of Geneva, Geneva, 
      Switzerland (Hafezi, Torres-Netto); Department of Ophthalmology, University of 
      Southern California, Los Angeles, California (Hafezi); Department of 
      Ophthalmology, Antwerp University Hospital, Edegem, Belgium (Koppen, Rozema); 
      Division of Ophthalmology, School of Medicine, Universidad Miguel Hernandez, 
      Alicante, Spain (Alio del Barrio); Cornea, Cataract and Refractive Surgery Unit, 
      Vissum (Miranza Group), Alicante, Spain (Alio del Barrio); Emmetropia 
      Mediterranean Eye Institute, Heraklion, Crete, Greece (Aslanides); The American 
      University of Beirut Medical Center, Beirut, Lebanon (Awwad); The Department of 
      Ophthalmology, Brussels University Hospital, Brussels, Belgium (Ni Dhubhghaill); 
      The faculty of Health Sciences and Pharmacy, Vrije Universiteit Brussel, 
      Brussels, Belgium (Ni Dhubhghaill); Department of Ophthalmology, Massachusetts 
      Eye and Ear and Harvard Medical School, Boston, Massachusetts (Pineda).
FAU - Hafezi, Farhad
AU  - Hafezi F
AUID- ORCID: 0000-0001-8935-4558
FAU - Koppen, Carina
AU  - Koppen C
AUID- ORCID: 0000-0002-7728-7260
FAU - Alio Del Barrio, Jorge L
AU  - Alio Del Barrio JL
AUID- ORCID: 0000-0003-2666-3366
FAU - Aslanides, Ioannis M
AU  - Aslanides IM
AUID- ORCID: 0000-0002-5926-775
FAU - Awwad, Shady T
AU  - Awwad ST
AUID- ORCID: 0000-0002-6100-0587
FAU - Ni Dhubhghaill, Sorcha
AU  - Ni Dhubhghaill S
AUID- ORCID: 0000-0002-1115-7834
FAU - Pineda, Roberto 2nd
AU  - Pineda R 2nd
AUID- ORCID: 0000-0002-1592-1991
FAU - Torres-Netto, Emilio A
AU  - Torres-Netto EA
AUID- ORCID: 0000-0002-9007-5895
FAU - Wang, Lin
AU  - Wang L
FAU - Chen, Shi-Hao
AU  - Chen SH
AUID- ORCID: 0000-0001-7646-8003
FAU - Cui, Le-Le
AU  - Cui LL
AUID- ORCID: 0000-0002-9408-4916
FAU - Rozema, Jos J
AU  - Rozema JJ
AUID- ORCID: 0000-0001-8124-8646
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Cataract Refract Surg
JT  - Journal of cataract and refractive surgery
JID - 8604171
SB  - IM
MH  - Humans
MH  - *Keratoconus/diagnosis
MH  - Case-Control Studies
MH  - Retrospective Studies
MH  - Tomography, Optical Coherence
MH  - *Epithelium, Corneal
MH  - ROC Curve
MH  - Corneal Topography
MH  - Cornea
EDAT- 2023/08/02 19:15
MHDA- 2023/11/06 06:42
CRDT- 2023/08/02 13:44
PHST- 2023/03/20 00:00 [received]
PHST- 2023/07/25 00:00 [accepted]
PHST- 2023/11/06 06:42 [medline]
PHST- 2023/08/02 19:15 [pubmed]
PHST- 2023/08/02 13:44 [entrez]
AID - 02158034-202311000-00004 [pii]
AID - 10.1097/j.jcrs.0000000000001276 [doi]
PST - ppublish
SO  - J Cataract Refract Surg. 2023 Nov 1;49(11):1098-1105. doi: 
      10.1097/j.jcrs.0000000000001276.