Superiority of Baseline Biomechanical Properties over Corneal Tomography in Predicting Keratoconus Progression

OBJECTIVES: To determine corneal biomechanical and tomographic factors associated with keratoconus (KC) progression. MATERIALS AND METHODS: This study included 111 eyes of 111 KC patients who were followed-up for at least 1 year. Progression was defined as the presence of progressive change between the first two consecutive baseline visits in any single parameter (A, B, or C) ≥95% confidence interval or two parameters ≥80% confidence interval for the KC population evaluated by the Belin ABCD progression display. The eye with better initial tomographic findings was chosen as the study eye. Analyzed Pentacam parameters were maximum keratometry (Kmax), minimum pachymetry (Kmin), central corneal thickness, thinnest corneal thickness, 90° vertical anterior and posterior coma data in Zernike analysis, and Belin Ambrosio Enhanced Ectasia Display Final D value. Corneal hysteresis (CH) and corneal resistance factor (CRF) were analyzed together with the waveform parameters obtained with Ocular Response Analyzer (ORA). Factors related to KC progression were evaluated using t-tests and logistic regression tests. Statistical significance was accepted as p<0.05. RESULTS: There were 44 (mean age: 27.1±8.5 years, female: 25) and 67 (mean age: 31.1±9.1 years, female: 36) patients in the progressive and non-progressive groups, respectively. Although Pentacam parameters along with CH and CRF were similar between the two groups, ORA waveform parameter derived from the second applanation signal p2area was statistically significantly lower in the progressive group (p=0.02). Each 100-unit decrease in p2area increased the likelihood of keratoconus progression by approximately 30% in the logistic regression analysis (β=0.707, p=0.001, model r2=0.27). CONCLUSION: Parameters derived from the second applanation signal of ORA may be superior to conventional ORA parameters and corneal tomography in predicting KC progression.