Epithelial, Stromal, and Total Corneal Thickness in Keratoconus: Three-dimensional Display With Artemis Very-high Frequency Digital Ultrasound

PURPOSE: To characterize the epithelial, stromal, and total corneal thickness profile in a population of eyes with keratoconus. METHODS: Epithelial, stromal, and total corneal thickness profiles were measured in vivo by Artemis very high-frequency (VHF) digital ultrasound scanning (Arc Scan) across the central 6- to 10-mm diameter of the cornea on 54 keratoconic eyes. Maps of the average, standard deviation, minimum, maximum, and range of epithelial, stromal, and total corneal thickness were plotted. The average location of the thinnest epithelium, stroma, and total cornea were found. The cross-sectional semi-meridional stromal and total corneal thickness profiles were calculated using annular averaging. The absolute stromal and total corneal thickness progressions relative to the thinnest point were calculated using annular averaging as well as for 8 semi-meridians individually. RESULTS: The mean corneal vertex epithelial, stromal, and total corneal thicknesses were 45.7 +/- 5.9 mu m, 426.4 +/- 38.5 mu m, and 472.2 +/- 41.4 mu m, respectively. The average epithelial thickness profile showed an epithelial doughnut pattern characterized by localized central thinning surrounded by an annulus of thick epithelium. The thinnest epithelium, stroma, and total cornea were displaced on average by 0.48 +/- 0.66 mm temporally and 0.32 +/- 0.67 mm inferiorly, 0.31 +/- 0.45 mm temporally and 0.54 +/- 0.37 mm inferiorly, and 0.31 +/- 0.43 mm temporally and 0.50 +/- 0.35 mm inferiorly, respectively, with reference to the corneal vertex. The increase in semi-meridional absolute stromal and total corneal thickness progressions was greatest inferiorly and lowest temporally. CONCLUSIONS: Three-dimensional thickness mapping of the epithelial, stromal, and total corneal thickness profiles characterized thickness changes associated with keratoconus and may help in early diagnosis of keratoconus. [J Refract Surg. 2010;26:259-271.] doi:10.3928/1081597X-20100218-01