Scleral Thickness in Eyes with Pachychoroid Pigment Epitheliopathy Accompanied by Keratoconus

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-04-26 DOI:10.1016/j.xops.2025.100808

Paolo Forte MD , Alessandro Feo MD , Hideki Koizumi MD, PhD , Enrico Borrelli MD, PhD , Riccardo Manocchio MD , Luca Di Cello MD, PhD , Francesco Biagini MD , Francesco Macocco MD , Gabriele Drago MD , Giovanni Forte MD , Aldo Vagge MD, PhD , Christian Gianoglio PhD , Vincenzo Fontana PhD , Michele Iester MD, PhD , Massimo Nicolò MD, PhD , Mario R. Romano MD, PhD , Chiara Bonzano MD, PhD

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Abstract

Purpose

To assess the prevalence of pachychoroid pigment epitheliopathy (PPE) in eyes with keratoconus (KC) and investigate its correlation with corneal, choroidal, and scleral indices with multimodal imaging.

Design

An exploratory, cross-sectional, cohort study.

Subjects

One hundred consecutive patients affected with KC.

Main Outcome Measures

Scleral stromal thickness, PPE prevalence, and their associations with corneal and choroidal parameters.

Methods

Demographic data, corneal collagen cross-linking, anamnestic records, and clinical findings were collected. Imaging protocol included OCT (Spectralis HRA+OCT; Heidelberg Engineering), corneal topography (TMS-4N, Tomey), corneal pachymetry (RTVue-XR Avanti, Optovue), and axial length (AXL) measurement (OA-2000, Tomey). Anterior scleral stromal thickness was measured in the horizontal gaze positions 6 mm posteriorly to the scleral spur (Spectralis HRA+OCT; linear 20° scan, 1024 A-scan per second). Odds ratios (ORs) and corresponding 95% confidence limits (95% CLs) were estimated through logistic regression analysis to evaluate the association between each study parameter and PPE. To accommodate for the potential clustering effect due to within-patient correlated eye data, a generalized estimating equation procedure was applied to regression analysis. Additionally, a decision tree machine learning model with K-fold cross-validation was employed to predict PPE.

Results

Eighty-five Caucasian patients were eligible for analysis (mean age: 34.2 years, standard deviation: 8.7). The prevalence of PPE was 10.5% (95% CL: 4.9/19.1%; 9/85 patients; 11/170 eyes; 2 bilateral cases). Significant predictors for PPE according to logistic regression were choroidal thickness (OR: 4.51; 95% CL: 1.50/13.6 for 50 μm increments; P = 0.007), age (OR: 4.61; 95% CL: 1.30/16.4 for 10-year increments; P = 0.018), and scleral stromal thickness (OR: 7.48: 95% CL: 1.69/33.1 for 25 μm increments; P = 0.008). Sex, AXL, corneal curvature, and astigmatism parameters did not show significant discriminant ability (P > 0.05). Collagen cross-linking treatment was performed in a comparable proportion between the 2 groups (73.6% vs. 63.4% in PPE and non-PPE, respectively).

Conclusions

Our study identifies increased scleral thickness as the key predictor of PPE in KC patients, followed by choroidal thickening and increased age. These findings provide new insights into the role of scleral biomechanics in KC eyes with PPE.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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厚脉络膜色素上皮病伴圆锥角膜的巩膜厚度

目的评价圆锥角膜（KC）患者厚脉络膜色素上皮病（PPE）的患病率，探讨其与角膜、脉络膜和巩膜指标的相关性。设计一项探索性、横断面、队列研究。研究对象：连续100例kc患者。主要观察指标：巩膜间质厚度、PPE患病率及其与角膜和脉络膜参数的关系。方法收集患者的人口学资料、角膜胶原交联、记忆记录和临床表现。成像方案包括OCT (Spectralis HRA+OCT；Heidelberg Engineering)，角膜地形图（TMS-4N, Tomey），角膜厚度测量（RTVue-XR Avanti, Optovue）和轴长（AXL）测量（ova -2000, Tomey）。在距巩膜骨刺后方6 mm的水平凝视位置测量前巩膜间质厚度(Spectralis HRA+OCT；线性20°扫描，每秒1024次扫描)。通过logistic回归分析估计比值比（ORs）和相应的95%置信限（95% CLs），以评估每个研究参数与PPE之间的相关性。为了适应潜在的聚类效应，由于患者内部相关的眼睛数据，一个广义估计方程程序应用于回归分析。此外，采用具有K-fold交叉验证的决策树机器学习模型来预测PPE。结果符合分析条件的白人患者85例（平均年龄34.2岁，标准差8.7）。PPE患病率为10.5% (95% CL: 4.9/19.1%；9/85的病人;11/170的眼睛;2例双侧病例)。根据logistic回归，PPE的显著预测因子为脉络膜厚度(OR: 4.51；≥50 μm时，95% CL: 1.50/13.6；P = 0.007)、年龄(OR: 4.61；10年的95% CL: 1.30/16.4；P = 0.018)，巩膜间质厚度(OR: 7.48: 95% CL: 1.69/33.1；P = 0.008)。性别、AXL、角膜曲率和散光参数没有显著的区分能力(P >；0.05)。两组之间进行胶原交联治疗的比例相当（PPE组和非PPE组分别为73.6%和63.4%）。结论我们的研究发现巩膜厚度增加是KC患者PPE的关键预测因素，其次是脉络膜增厚和年龄增加。这些发现为巩膜生物力学在患PPE的KC眼中的作用提供了新的见解。财务披露作者在本文中讨论的任何材料中没有专有或商业利益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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