ABSTRACT
PURPOSE: To establish new criteria for the progression of keratoconus, taking into account a Pentacam HR (high resolution) tomographers repeatability limit. METHODS: This is a retrospective observational study, including 224 eyes in 154 patients diagnosed with keratoconus and patients treated with crosslinking, with a follow-up of at least one year, in which the new progression score of the Cruces University Hospital for keratoconus progression was analyzed. This score takes into account: maximum keratometry, thinnest corneal thickness, maximum posterior elevation, vertical coma and RMS of high order aberrations, all based on the tomographer repeatability limit. The effectiveness or not of crosslinking was determined. RESULTS: The Receiver Operating Characteristics (ROC) curves obtained in our validation met the criteria by being far from the reference diagonal. Moreover, young patients are more likely to have keratoconus that progresses, and the percentage of patients that showed progression was 14.3% of the eyes studied, with the most advanced keratoconus showing the least progression. Taking into account the new progression score of the Cruces Hospital, we would have indicated crosslinking in 2 eyes only and we observed that none progressed one year after treatment. CONCLUSIONS: The the new progression score of the Cruces University Hospital is a method based on the real repeatability limit for keratoconic eyes. Moreover, it is easy to interpret and can be implemented with Pentacam software. It provides a numerical value that evaluates both the anterior and posterior surfaces of the cornea and corneal aberrations in the evolution of keratoconus.
ABSTRACT
Purpose: To determine and compare the serum levels of complement Factor H (FH), monomeric C-Reactive Protein (mCRP) and pentameric C-Reactive protein (pCRP) in patients with age-related macular degeneration (AMD) and to correlate them with clinical, structural and functional parameters. Methods: Cross-sectional observational study. One hundred thirty-nine individuals (88 patients and 51 healthy controls) from two referral centers were included and classified into three groups: early or intermediate AMD (n=33), advanced AMD (n=55), and age and sex matched healthy controls (n=51). Serum levels of FH, mCRP, and pCRP were determined and correlated with clinical and imaging parameters. Results: Patients with intermediate AMD presented FH levels significantly lower than controls [186.5 (72.1-931.8) µg/mL vs 415.2 (106.1-1962.2) µg/mL; p=0.039] and FH levels <200 µg/mL were associated with the presence of drusen and pigmentary changes in the fundoscopy (p=0.002). While no differences were observed in pCRP and mCRP levels, and mCRP was only detected in less than 15% of the included participants, women had a significantly higher detection rate of mCRP than men (21.0% vs. 3.8%, p=0.045). In addition, the ratio mCRP/FH (log) was significantly lower in the control group compared to intermediate AMD (p=0.031). Visual acuity (p<0.001), macular volume (p<0.001), and foveal thickness (p=0.034) were significantly lower in the advanced AMD group, and choroidal thickness was significantly lower in advanced AMD compared to early/intermediate AMD (p=0.023). Conclusion: Intermediate AMD was associated in our cohort with decreased serum FH levels together with increased serum mCRP/FH ratio. All these objective serum biomarkers may suggest an underlying systemic inflammatory process in early/intermediate AMD patients.
