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Niklas Telinius, Niklas Telinius, Peter Ott, Jesper Hjortdal; Quantification of Kayser-Fleischer ring using Scheimpflug imaging. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1927.
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© 2017 Association for Research in Vision and Ophthalmology.
In Wilson’s disease (WD) a defect in cellular copper transport leads to accumulation of copper in tissues, which can be seen in the eye as a Kayser-Fleischer ring (KFR). The KFR can be used to diagnose and monitor the disease. The purpose of this study was to assess if Scheimpflug imaging can be used to visualize KFR and provide an objective way to quantify KFR.
The study was a retrospective study of 16 patients with WD. All patients were examined with slit lamp and Schempflug imaging (Pentacam, Oculus) as part of routine clinical practice. Clinical examination was conducted by one of two cornea specialists. Pentacam images were analyzed in ImageJ. The inferior part of cornea was analyzed by measuring the brightness (0-256) in approximately 30 points along a line perpendicular to the corneal surface. 9 healthy volunteers of similar age were included as controls. Statistical analysis included one-way ANOVA and the post-Bonferroni test.
A KFR was identified on the inferior part of cornea on slit lamp examination in 7 out of 16 WD patients and confirmed on Pentacam images. The posterior part of cornea was significantly (p<0.05) brighter in WD patients with KFR compared to WD patients without KFR and controls; 220±19 compared to 106±14 and 92±10. When normalized to the peak value of the anterior cornea all patients with a KFR had a ratio over 1 (1.4±0.14) whereas all patients without KFR and controls had a ratio below 1 (0.64±0.1 and 0.66±0.1), p<0.05. There was no significant difference between controls and WD patients without KFR in absolute brightness or ratio (p>0.05). Four patients were examined 2 or 3 times over 2 years and the Pentacam images correlated with the slit lamp examination.
We conclude that Scheimpflug imaging can successfully visualize KFR and that the images can be used for quantification. The images correlated well with the slit lamp examination. Further analysis and follow up examinations are needed for determining the optimal way to use Scheimpflug imaging for monitoring KFR.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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