Keratoconus false-positive screening rates in eyes with pterygium: tomographic and biomechanical artifacts.

Purpose: To investigate tomographic and biomechanical screening artifacts associated with primary pterygium that may mimic keratoconus-like patterns before and after surgical excision.

Methods: Twenty-five eyes with primary pterygium underwent Scheimpflug corneal tomography and dynamic corneal response analysis before surgery and 3 months after excision. Tomographic and biomechanical (parameters were compared using paired analyses. The proportions of eyes exceeding established screening thresholds (Tomographic Biomechanical Index ≥0.29; Corvis Biomechanical Index ≥0.5) were compared using McNemar's test.

Results: BAD-D decreased significantly after surgery (1.69±1.22 vs. 1.36±0.90; Wilcoxon, p=0.027). Pentacam irregularity indices also improved significantly, including ISV (51.16±44.21 vs. 36.88±42.94; p<0.001) and IVA (0.39±0.29 vs. 0.30±0.32; p=0.006). No significant changes were observed in maximum keratometry, corneal astigmatism. The mean CBI decreased significantly (0.494±0.353 vs. 0.384±0.298; p=0.048), and the proportion of CBI-positive eyes (≥0.5) declined from 48% (12/25) to 28% (7/25). In contrast, the mean tomographic Biomechanical Index did not change remained unchanged (0.519±0.313 vs. 0.534±0.323; p=0.909), and the proportion of Tomographic Biomechanical Index-positive eyes (≥0.29) remained 76% (19/25). The number of topographic keratoconus classification positive eyes decreased from 8 (32%) to 3 (12%). Integrated Radius showed no significant postoperative change (p=0.131).

Conclusions: Primary pterygium was associated with tomographic and biomechanical screening abnormalities that mimicked keratoconus-like patterns. Following surgical excision, anterior tomographic parameters improved, and the proportion of Corvis biomechanical index-positive eyes decreased. In contrast, Tomographic Biomechanical Index remained elevated in most eyes, and stiffness-related biomechanical parameters showed no significant change. These findings demonstrate a differential postoperative response among screening indices and suggest that pterygium-induced anterior corneal surface distortion may increase false-positive keratoconus screening rates, particularly for Tomographic Biomechanical Index, which may remain elevated even after lesion removal.