1. Rio de Janeiro Corneal Tomography and Biomechanics Study Group CONCOMITANT KERATOCONUS AND FUCHS DYSTROPHY: TWO DISEASES IS BETTER THAN JUST ONE? Dr. Ambrósio is consultant for Oculus Optikgeräte GmbH (Wetzlar, Germany) Isaac C. Ramos, Isabela Delpizzo, Bruno de F. Valbon, Leonardo N. Pimentel, Diogo L. Caldas, Ana Laura C. Canedo, Renato Ambrósio Jr.

2. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Introduction  While thinning is a hallmark of ectatic diseases, thickening is the consequence of endothelial failure. Thereby, keratoconus and Fuchs Dystrophy may “neutralize” each other in the pathophysiologic process. Keratoconus Corneal Guttata Keratoconus + Corneal Guttata Corneal Thickness

3. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Purpose  To compare the visual performance, along with tomographic and biomechanical findings among cases with keratoconus and cases with concomitant keratoconus and corneal guttata.

4. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Methods  Visual performance, along with tomographic and biomechanical findings were compared among 21 eyes from 21 patients with Keratoconus (group 1) and 22 eyes from eleven patients with concomitant keratoconus and corneal guttata (group 2).  The non-parametric Wilcoxon–Mann–Whitney test was used to assess different distributions among paired groups.

5. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Methods  Twenty-two eyes from eleven patients with concomitant keratoconus and corneal guttata (group 2) were confirmed by clinical examination, specular microscopy and Scheimpflug based corneal tomo- graphy. Non contact tonometry and biomechanical analysis was also performed with ORA. Camel’s second hum sign

6. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Results  There was a statistically lower K2, keratometric astigmatism and pachymetric progression indices (min, ave and max) in the keratoconus and guttata group compared to the group with keratoconus (Wilcoxon- Mann-Whitney test, p<0.05). KK+G K2 P = 0.0491 KK+G Min43,642,4 Avg48,1946,08 Max61,153,5 P = 0.0026 KK+G K Min0,40,1 Avg3,831,63 Max8,14,9 ∆k

7. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Results  There was a statistically lower K2, keratometric astigmatism and pachymetric progression indices (min, ave and max) in the keratoconus and guttata group compared to the group with keratoconus (Wilcoxon- Mann-Whitney test, p<0.05). PPI MinPPI AvgPPI Max P = 0.04P = 0.0012P = 0.0022 KK+GK K K Min0,340,2 Avg1,170,83 Max2,152,03 KK+G Min0,610,7 Avg1,731,24 Max2,492,73 KK+G Min0,810,88 Avg2,501,79 Max3,964,67

8. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Results Example case with keratoconus in OD (normal endothelium) and relatively normal tomography in the left eye with endothelial changes on specular microscopy. Sagital MapElevation Back MapSagital MapElevation Back Map ODOS

9. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Results  There was no statistically difference in CRF and CH (p = 0,9516; p = 0,7986) between groups 1 and 2. Keratoconus Keratoconus + Corneal Guttata CRFCH Min3,93,1 Avg7,758,43 Max12,612,8 CRFCH Min3,44,1 Avg7,678,23 Max11,310,9 Signal Time Response Signal Time Response

10. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Results  The group with keratoconus and corneal guttata showed statistically better CDVA (Corrected Distance Visual Acuity) than keratoconus group. (Wilcoxon-Mann-Whitney test, p<0.05) P = 0.0047 CDVA (LogMAR) KK+G KKG Min0.060 Avg0.340.20 Max11.90 LogMARSnellen 0.3420/44 0.2020/32

11. Rio de Janeiro Corneal Tomography and Biomechanics Study Group Conclusions  The concomitance of keratoconus and endothelial disease seems to reduce the severity of ectasia which is observed on corneal tomo- graphy, but it does not affect biomechanical measurements.  The visual performance on the group with concomitant keratoconus and corneal guttata was better than the group with keratoconus.

12. Rio de Janeiro Corneal Tomography and Biomechanics Study Group