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• W2912591148 abstract "We would like to comment some aspects of the interesting article published in your journal concerning a comparison between standard cross-linking (CXL) and photorefractive keratectomy (PRK) combined with accelerated cross-linking (AXL) for keratoconus management (Iqbal et al. 2018). We appreciated the use of Pentacam HR instead of ultrasound pachymetry to evaluate corneal thickness. Ultrasound pachymetry, currently considered the gold standard for these measurements, has indeed several limitations: the exact axial placement of the probe at the corneal centre and the reproducibility of measurements are strongly associated with the examiner's expertise and can be influenced by the use of different anaesthetic drops during the follow-up examinations. Moreover, ultrasound pachymetric measurements are influenced by the amount of corneal water, as in case of corneal oedema or corneal stiffness because the sound speed is lower in case of oedematous tissues, making such measurements even larger, and higher in case of stiff tissues, making them even smaller (De Bernardo & Rosa 2017). In addition, Pentacam HR is able to measure both the central corneal thickness (CCT) and the corneal volume that is, in our opinion, much more sensitive in evaluating eventual keratoconus progression. In fact, further ecstasies and thinning could involve corneal regions different from the central one, and they could be overlooked if CCT alone is evaluated (De Bernardo & Rosa 2018). However, our main concern is that, according to the published data, the astigmatic correction seems to have been assessed without taking into account eventual astigmatic axis changes. When the astigmatic correction needs to be estimated, to evaluate the changes in the astigmatic axis is mandatory, because a cylindrical correction misalignment will result in an astigmatic under correction and a spherical change and the only way to detect such influence is the vector analysis (Rosa et al. 2012). Lastly, the authors included in their study 125 eyes of 75 patients. From this number, it is clear that, in some patients, both eyes and, in the others, only one eye have been evaluated, introducing in this way a bias, decreasing the power of the study (De Bernardo et al. 2017)." @default.
• W2912591148 created "2019-02-21" @default.
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• W2912591148 date "2019-01-28" @default.
• W2912591148 modified "2023-10-14" @default.
• W2912591148 title "Vector analysis and Pentacam to compare standard cross‐linking and photorefractive keratectomy combined with accelerated cross‐linking in keratoconus management" @default.
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• W2912591148 doi "https://doi.org/10.1111/aos.14037" @default.
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