Extremely asymmetric ectasia: Tomographically unilateral keratoconus
Purpose To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC). Methods In this retrospective case–control study, strict unilaterality criteria were applied to select tomographically unilateral cases with ≥3 years of follow‐up. For comparison, a...
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| Published in: | Acta ophthalmologica (Oxford, England) Vol. 103; no. 5; pp. 530 - 538 |
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| Main Authors: | , , , , , , |
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01.08.2025
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| ISSN: | 1755-375X, 1755-3768, 1755-3768 |
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| Abstract | Purpose
To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC).
Methods
In this retrospective case–control study, strict unilaterality criteria were applied to select tomographically unilateral cases with ≥3 years of follow‐up. For comparison, a healthy cohort and two bilateral KC cohorts were matched to the tomographically unilateral cases. All patients were selected from The Rotterdam Eye Hospital, whereas healthy controls were selected from the population‐based Rotterdam Study. After cohort selection, several risk factors and 25 Pentacam features were assessed. Unaffected (i.e. tomographically non‐keratoconic) eyes from the tomographically unilateral cases were compared to matched healthy eyes, matched bilateral KC eyes and affected unilateral KC eyes. Furthermore, affected tomographically unilateral KC eyes were compared to matched bilateral KC eyes. Statistical analysis relied on Wilcoxon signed‐rank tests and conditional logistic regression.
Results
From 1006 assessed cases, 18 (1.8%) tomographically unilateral cases were selected. Their median (interquartile range) follow‐up was 5.7 (4.3–8) years. Eczema and asthma were more prevalent among tomographically unilateral patients (28% each) compared to bilateral patients (6% and 9%) (p = 0.01 and p = 0.05, signed‐rank test). We could not detect meaningful Pentacam differences between unaffected unilateral eyes and matched healthy eyes. Expectedly, significant differences were detected between unaffected unilateral eyes and affected (bilateral or unilateral) eyes. Lastly, the ectatic features of affected unilateral eyes seemed comparable to their bilateral counterparts, but their high‐order aberrations were significantly lower.
Conclusion
Our findings support the existence of tomographically unilateral KC. Understanding how tomographic unilaterality ensues may offer valuable insights into KC aetiology. |
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| AbstractList | To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC).
In this retrospective case-control study, strict unilaterality criteria were applied to select tomographically unilateral cases with ≥3 years of follow-up. For comparison, a healthy cohort and two bilateral KC cohorts were matched to the tomographically unilateral cases. All patients were selected from The Rotterdam Eye Hospital, whereas healthy controls were selected from the population-based Rotterdam Study. After cohort selection, several risk factors and 25 Pentacam features were assessed. Unaffected (i.e. tomographically non-keratoconic) eyes from the tomographically unilateral cases were compared to matched healthy eyes, matched bilateral KC eyes and affected unilateral KC eyes. Furthermore, affected tomographically unilateral KC eyes were compared to matched bilateral KC eyes. Statistical analysis relied on Wilcoxon signed-rank tests and conditional logistic regression.
From 1006 assessed cases, 18 (1.8%) tomographically unilateral cases were selected. Their median (interquartile range) follow-up was 5.7 (4.3-8) years. Eczema and asthma were more prevalent among tomographically unilateral patients (28% each) compared to bilateral patients (6% and 9%) (p = 0.01 and p = 0.05, signed-rank test). We could not detect meaningful Pentacam differences between unaffected unilateral eyes and matched healthy eyes. Expectedly, significant differences were detected between unaffected unilateral eyes and affected (bilateral or unilateral) eyes. Lastly, the ectatic features of affected unilateral eyes seemed comparable to their bilateral counterparts, but their high-order aberrations were significantly lower.
Our findings support the existence of tomographically unilateral KC. Understanding how tomographic unilaterality ensues may offer valuable insights into KC aetiology. Purpose To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC). Methods In this retrospective case–control study, strict unilaterality criteria were applied to select tomographically unilateral cases with ≥3 years of follow‐up. For comparison, a healthy cohort and two bilateral KC cohorts were matched to the tomographically unilateral cases. All patients were selected from The Rotterdam Eye Hospital, whereas healthy controls were selected from the population‐based Rotterdam Study. After cohort selection, several risk factors and 25 Pentacam features were assessed. Unaffected (i.e. tomographically non‐keratoconic) eyes from the tomographically unilateral cases were compared to matched healthy eyes, matched bilateral KC eyes and affected unilateral KC eyes. Furthermore, affected tomographically unilateral KC eyes were compared to matched bilateral KC eyes. Statistical analysis relied on Wilcoxon signed‐rank tests and conditional logistic regression. Results From 1006 assessed cases, 18 (1.8%) tomographically unilateral cases were selected. Their median (interquartile range) follow‐up was 5.7 (4.3–8) years. Eczema and asthma were more prevalent among tomographically unilateral patients (28% each) compared to bilateral patients (6% and 9%) (p = 0.01 and p = 0.05, signed‐rank test). We could not detect meaningful Pentacam differences between unaffected unilateral eyes and matched healthy eyes. Expectedly, significant differences were detected between unaffected unilateral eyes and affected (bilateral or unilateral) eyes. Lastly, the ectatic features of affected unilateral eyes seemed comparable to their bilateral counterparts, but their high‐order aberrations were significantly lower. Conclusion Our findings support the existence of tomographically unilateral KC. Understanding how tomographic unilaterality ensues may offer valuable insights into KC aetiology. To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC).PURPOSETo investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC).In this retrospective case-control study, strict unilaterality criteria were applied to select tomographically unilateral cases with ≥3 years of follow-up. For comparison, a healthy cohort and two bilateral KC cohorts were matched to the tomographically unilateral cases. All patients were selected from The Rotterdam Eye Hospital, whereas healthy controls were selected from the population-based Rotterdam Study. After cohort selection, several risk factors and 25 Pentacam features were assessed. Unaffected (i.e. tomographically non-keratoconic) eyes from the tomographically unilateral cases were compared to matched healthy eyes, matched bilateral KC eyes and affected unilateral KC eyes. Furthermore, affected tomographically unilateral KC eyes were compared to matched bilateral KC eyes. Statistical analysis relied on Wilcoxon signed-rank tests and conditional logistic regression.METHODSIn this retrospective case-control study, strict unilaterality criteria were applied to select tomographically unilateral cases with ≥3 years of follow-up. For comparison, a healthy cohort and two bilateral KC cohorts were matched to the tomographically unilateral cases. All patients were selected from The Rotterdam Eye Hospital, whereas healthy controls were selected from the population-based Rotterdam Study. After cohort selection, several risk factors and 25 Pentacam features were assessed. Unaffected (i.e. tomographically non-keratoconic) eyes from the tomographically unilateral cases were compared to matched healthy eyes, matched bilateral KC eyes and affected unilateral KC eyes. Furthermore, affected tomographically unilateral KC eyes were compared to matched bilateral KC eyes. Statistical analysis relied on Wilcoxon signed-rank tests and conditional logistic regression.From 1006 assessed cases, 18 (1.8%) tomographically unilateral cases were selected. Their median (interquartile range) follow-up was 5.7 (4.3-8) years. Eczema and asthma were more prevalent among tomographically unilateral patients (28% each) compared to bilateral patients (6% and 9%) (p = 0.01 and p = 0.05, signed-rank test). We could not detect meaningful Pentacam differences between unaffected unilateral eyes and matched healthy eyes. Expectedly, significant differences were detected between unaffected unilateral eyes and affected (bilateral or unilateral) eyes. Lastly, the ectatic features of affected unilateral eyes seemed comparable to their bilateral counterparts, but their high-order aberrations were significantly lower.RESULTSFrom 1006 assessed cases, 18 (1.8%) tomographically unilateral cases were selected. Their median (interquartile range) follow-up was 5.7 (4.3-8) years. Eczema and asthma were more prevalent among tomographically unilateral patients (28% each) compared to bilateral patients (6% and 9%) (p = 0.01 and p = 0.05, signed-rank test). We could not detect meaningful Pentacam differences between unaffected unilateral eyes and matched healthy eyes. Expectedly, significant differences were detected between unaffected unilateral eyes and affected (bilateral or unilateral) eyes. Lastly, the ectatic features of affected unilateral eyes seemed comparable to their bilateral counterparts, but their high-order aberrations were significantly lower.Our findings support the existence of tomographically unilateral KC. Understanding how tomographic unilaterality ensues may offer valuable insights into KC aetiology.CONCLUSIONOur findings support the existence of tomographically unilateral KC. Understanding how tomographic unilaterality ensues may offer valuable insights into KC aetiology. Purpose To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC). Methods In this retrospective case–control study, strict unilaterality criteria were applied to select tomographically unilateral cases with ≥3 years of follow‐up. For comparison, a healthy cohort and two bilateral KC cohorts were matched to the tomographically unilateral cases. All patients were selected from The Rotterdam Eye Hospital, whereas healthy controls were selected from the population‐based Rotterdam Study. After cohort selection, several risk factors and 25 Pentacam features were assessed. Unaffected (i.e. tomographically non‐keratoconic) eyes from the tomographically unilateral cases were compared to matched healthy eyes, matched bilateral KC eyes and affected unilateral KC eyes. Furthermore, affected tomographically unilateral KC eyes were compared to matched bilateral KC eyes. Statistical analysis relied on Wilcoxon signed‐rank tests and conditional logistic regression. Results From 1006 assessed cases, 18 (1.8%) tomographically unilateral cases were selected. Their median (interquartile range) follow‐up was 5.7 (4.3–8) years. Eczema and asthma were more prevalent among tomographically unilateral patients (28% each) compared to bilateral patients (6% and 9%) (p = 0.01 and p = 0.05, signed‐rank test). We could not detect meaningful Pentacam differences between unaffected unilateral eyes and matched healthy eyes. Expectedly, significant differences were detected between unaffected unilateral eyes and affected (bilateral or unilateral) eyes. Lastly, the ectatic features of affected unilateral eyes seemed comparable to their bilateral counterparts, but their high‐order aberrations were significantly lower. Conclusion Our findings support the existence of tomographically unilateral KC. Understanding how tomographic unilaterality ensues may offer valuable insights into KC aetiology. |
| Author | Meester‐Smoor, Magda A. Dooren, Bart T. H. Rizopoulos, Dimitris Shabani, Hasan Ramdas, Wishal D. Klaver, Caroline C. W. Geerards, Annette J. M. |
| AuthorAffiliation | 4 Department of Biostatistics, Erasmus MC Erasmus University Medical Center Rotterdam The Netherlands 6 Amphia Hospital Breda The Netherlands 5 Department of Ophthalmology Radboud University Medical Center Nijmegen The Netherlands 1 Department of Ophthalmology, Erasmus MC Erasmus University Medical Center Rotterdam The Netherlands 2 Department of Epidemiology, Erasmus MC Erasmus University Medical Center Rotterdam The Netherlands 3 Cornea Center Rotterdam Eye Hospital Rotterdam The Netherlands |
| AuthorAffiliation_xml | – name: 3 Cornea Center Rotterdam Eye Hospital Rotterdam The Netherlands – name: 1 Department of Ophthalmology, Erasmus MC Erasmus University Medical Center Rotterdam The Netherlands – name: 5 Department of Ophthalmology Radboud University Medical Center Nijmegen The Netherlands – name: 2 Department of Epidemiology, Erasmus MC Erasmus University Medical Center Rotterdam The Netherlands – name: 6 Amphia Hospital Breda The Netherlands – name: 4 Department of Biostatistics, Erasmus MC Erasmus University Medical Center Rotterdam The Netherlands |
| Author_xml | – sequence: 1 givenname: Hasan orcidid: 0009-0000-6626-8518 surname: Shabani fullname: Shabani, Hasan email: h.shabani@erasmusmc.nl organization: Rotterdam Eye Hospital – sequence: 2 givenname: Wishal D. orcidid: 0000-0002-1780-5281 surname: Ramdas fullname: Ramdas, Wishal D. organization: Erasmus University Medical Center – sequence: 3 givenname: Magda A. surname: Meester‐Smoor fullname: Meester‐Smoor, Magda A. organization: Erasmus University Medical Center – sequence: 4 givenname: Dimitris surname: Rizopoulos fullname: Rizopoulos, Dimitris organization: Erasmus University Medical Center – sequence: 5 givenname: Caroline C. W. orcidid: 0000-0002-2355-5258 surname: Klaver fullname: Klaver, Caroline C. W. organization: Radboud University Medical Center – sequence: 6 givenname: Bart T. H. surname: Dooren fullname: Dooren, Bart T. H. organization: Amphia Hospital – sequence: 7 givenname: Annette J. M. surname: Geerards fullname: Geerards, Annette J. M. organization: Rotterdam Eye Hospital |
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| Keywords | keratoconus aetiology Scheimpflug tomography keratoconus very asymmetric ectasia keratoconus epidemiology unilateral keratoconus keratoconus risk factors forme fruste keratoconus |
| Language | English |
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To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC).
Methods
In this retrospective... To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC). In this retrospective case-control study, strict... Purpose To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC). Methods In this retrospective... To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC).PURPOSETo investigate the characteristics of... |
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| SubjectTerms | Adult Case-Control Studies Cornea - pathology Corneal Pachymetry Corneal Topography - methods Dilatation, Pathologic - diagnosis Eczema Female Follow-Up Studies forme fruste keratoconus Humans Keratoconus Keratoconus - diagnosis keratoconus aetiology keratoconus epidemiology keratoconus risk factors Male Middle Aged Original Population studies Retrospective Studies Risk Factors Scheimpflug tomography Statistical analysis unilateral keratoconus very asymmetric ectasia Visual Acuity Young Adult |
| Title | Extremely asymmetric ectasia: Tomographically unilateral keratoconus |
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