Analysis of Choroidal Vascularity Index in Keratoconus Patients Using Swept-Source Optical Coherence Tomography-Based Binarization Techniques

PURPOSE: To analyse the vascular density of the choroid in a keratoconus (KC) population using swept-source optical coherence tomography (SS-OCT). METHODS: Prospective, noninterventional study that analysed 97 eyes from 52 KC patients and 145 eyes from 89 healthy controls. The sample was divided in four different age groups. Inclusion criteria were topographic diagnosis of KC using Pentacam, axial length shorter than 26 mm, good quality of the images, and no other systemic or ocular diseases. A 12 mm horizontal single-line SS-OCT b-scan was performed to create a choroidal thickness (CT) profile. Validated automated segmentation and binarization were used in order to analyse choroidal, stromal, and vascular areas. RESULTS: The percentage of choroidal vascularity (vascular area/total area) was 56.6% in KC patients vs. 49.4% in controls. Aged-adjusted choroidal, stromal, and vascular areas and corrected choroidal percentage of vascularity are statistically increased in KC patients when compared with healthy controls (p < 0.001). All these parameters show a decreasing trend with age. Both stromal and vascular areas were thicker in KC patients (p < 0.001). CONCLUSIONS: Choroidal, stromal, and vascular areas and corrected choroidal percentage of vascularity are statistically increased in KC patients when compared with healthy controls. All these parameters tend to decrease with age.