Jack T.

Holladay, MD, MSEE, FACS 2006

Kerataconus
Kerataconus v.
v. HCL
HCL Warpage
Warpage
Topography &
Factor Keratocone HCL
Tomography 1. K’s > 46 < 46
2. Pattern Asymmetry Symmetry
3. Shape Circle Smile
4. Location Not @ 6 Always @ 6
Use in detecting Corneal 5. Pachy Thin@ cone NL@ smile
Thinning & Ectatic Disorders
6. History
7/10/2006 JTH 2 Familial Wears CLs

7/10/2006 JTH 3 7/10/2006 JTH 4

7/10/2006 JTH 5 7/10/2006 JTH 6

Detecting Ectasia & Keratoconus with the Pentacam Page 1 of 5

 Jack T. Holladay, MD, MSEE, FACS 2006

Tomography

Oculus
Pentacam
Use in detecting Corneal
7/10/2006 JTH 7 Ectatic Disorders

7/10/2006 JTH 9 7/10/2006 JTH 10

Corneal
Corneal Ectasia
Ectasia
z By definition is a “thinning”
thinning” with anterior movement
z K-conus:
conus: posterior surface 1st detectable move,
move,
because epithelium thins and “masks”
masks” anterior
movement of Bowman’
Bowman’s Membrane
z ˆ posterior surface float is more sensitive IF
ACCURATE … NOT ARTIFACT!
z Most prior reports are artifact due to Posterior
Surface is VIRTUAL IMAGE seen through
Anterior Surface and is distorted by Refractive
Surgery … oblate, blend zone, etc.
7/10/2006 JTH 11 7/10/2006 JTH 12

Detecting Ectasia & Keratoconus with the Pentacam Page 2 of 5

 Jack T. Holladay, MD, MSEE, FACS 2006

7/10/2006 JTH 13 7/10/2006 JTH 14

DO
DO NOT
NOT USE
USE B est FFit
Best it Sphere
Sphere USE
USE Best
Best Fit
Fit Toric
Toric Ellipsoide
Ellipsoide to
to
Prolate Cornea for
for Prolate
Prolate Cornea
Cornea Prolate
Prolate Cornea
Cornea
Prolate Cornea Best Fit
Best Fit Sphere With Toric Ellipsoid
Ectasia
Always Above BFS
in center

Only detects
Irregularities
Always Below BFS
in periphery From Prolate
Surface
Amount depends
On Asphericity
Of Cornea

7/10/2006 JTH 15 7/10/2006 JTH 16

7/10/2006 JTH 17 7/10/2006 JTH 18

Detecting Ectasia & Keratoconus with the Pentacam Page 3 of 5

 Jack T. Holladay, MD, MSEE, FACS 2006

CORNEA IS MENISCUS – ALWAYS THINNEST IN THE CENTER “RELATIVE PACHYMETRY MAP”

MAP” SHOWS RELATIVE THICKNESS AT EVERY POINT

7/10/2006 JTH 19 7/10/2006 JTH 20

7/10/2006 JTH 21 Advanced Keratoconus 7/10/2006 JTH 22

7/10/2006 JTH 23 7/10/2006 JTH 24

Detecting Ectasia & Keratoconus with the Pentacam Page 4 of 5

 Jack T. Holladay, MD, MSEE, FACS 2006

Conclusion
Conclusion !Thank You!
z Pentacam Scheimpflug very
sensitive detection of thinning
disorders (Cone,Pellucid
(Cone,Pellucid),), if use …
z Tangential (local radius) Map to
determine “nipple”
nipple” on front
z Toric Ellipsoid Float (not BFS) with
Elevation Maps to determine location
of protrusions in back and front
surface
z RELATIVE Pachymetry Map to
determine Thinnest Relative Point
7/10/2006 JTH 25 7/10/2006 JTH 26

Detecting Ectasia & Keratoconus with the Pentacam Page 5 of 5