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Pellucid marginal degeneration versus keratoconus: distinction with wide-field SD-OCT corneal sublayer pachymetry
  1. Niklas Mohr1,
  2. Mehdi Shajari1,2,
  3. Daniel Krause1,
  4. Stefan Kassumeh1,
  5. Jakob Siedlecki1,3,
  6. Siegfried G Priglinger1,3,
  7. Wolfgang J Mayer1,
  8. Nikolaus Luft1,3
  1. 1 Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
  2. 2 Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany
  3. 3 SMILE Eyes Clinic, Linz, Austria
  1. Correspondence to Nikolaus Luft, Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany; nikolaus.luft{at}


Purpose To evaluate the capability of wide-field spectral-domain optical coherence tomography (SD-OCT) corneal sublayer pachymetry to distinguish between keratoconus and pellucid marginal degeneration (PMD).

Methods This prospective cross-sectional study included 69 eyes (59 with keratoconus and 10 with PMD) of 69 patients. All patients were examined three subsequent times with the RTVue XR system. Pachymetry maps of the total cornea (CT), the epithelium (ET) and the stroma were generated using the onboard software. For analysis of reliability, the coefficients of variation and intraclass correlation coefficients (ICC) were calculated. Receiver operating characteristic analyses were performed to elaborate the most accurate pachymetric parameters for distinguishing between PMD and keratoconus.

Results Overall repeatability of (sublayer) pachymetry was comparably good in both keratoconus (ICC ranging between 0.827 and 0.986) and PMD (ICC ranging between 0.753 and 0.998). Measurement reliability in keratoconic eyes was a negative function of Kmax (p<0.05). As compared with keratoconus, PMD exhibited higher CT (526±31 µm vs 503±30 µm; p=0.02) and ET (56±7 µm vs 51±5 µm; p=0.02) in the inferotemporal 2–5 mm sector as well as lower ET in the inferior 7–9 mm sector (52±5 µm vs 57±5 µm; p<0.01). The calculated ratio between CT in the inferotemporal 2–5 mm and in the inferior 7–9 mm sector yielded the highest diagnostic accuracy for distinguishing between PMD and keratoconus with an area under the curve of 0.977 and an optimal cut-off value of 0.90.

Conclusion Wide-field SD-OCT corneal sublayer pachymetry showed good reliability in PMD and keratoconus and may be useful to differentiate between the two ectatic diseases.

  • Cornea
  • Degeneration
  • Imaging

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  • NM and MS contributed equally to this work.

  • Contributors NL, MS, WJM and SP conceived the study and were in charge of overall direction and planning. MS, NL, SK, JS, NM and DK acquired the subjects for the study. WJM, SP, NL and MS provided the technical devices used in the study. MS performed the clinical slit-lamp examinations. NM and DK performed the OCT measurements. NM, JS and SK performed the Pentacam measurements. NL, MS, NM and DK processed the data and made the division into the groups. NM, NL, DK and MS performed the statistical analysis and designed the figures. NM, MS and NL wrote the paper in consultation with all other authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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