A STEP-BY-STEP GUIDE TO INTERPRETING CORNEAL TOMOGRAPHY

The aim of this study is to present invaluable insights and provide systematic and step-by-step guidance into interpreting and thus optimizing the use of the Pentacam four-composite map in order to improve clinical outcomes and safety for the increasing numbers and expectations of cataract and refractive surgery patients.

Accurate interpretation of the four-composite map is essential for a thorough ophthalmological evaluation, providing deep insights into corneal biomechanics and refractive corneal assessment. Although it is an invaluable tool in refractive surgery and may currently be the most widely used tomographic map, it is common that it may not be fully understood by most of the surgeons that perform refractive surgery.

The PubMed, Cohrane Library and Embase databases were the main resources used to investigate the medical literature. The content of Cataract and Refractive Surgery course run by the Royal College Ophthalmologists in London as well as the content of the Cataract and Refractive Surgery Masterclass course of the Sinjab Academy were an adjunct source of information. The following keywords were used in various combinations: Ectasia, Keratoconus, corneal tomography, Pentacam, anterior optical coherence tomography.

The four composite map presents a combination of 4 maps for the 8mm cornea: one Sagital curvature anterior corneal surface map, two elevation maps (anterior and posterior) and the corneal thickness map. It also provides numerical information regarding cornea, pupil and anterior segment. This data offers a non-invasive, three-dimensional analysis of the cornea and anterior segment, and delivers critical information on corneal biomechanics. Accurate interpretation of this diagnostic tool has a critical role both in the diagnosis and monitoring of corneal ectasias and in the safe interpretation and monitoring of the cornea before and after the corneal refractive surgery and the non-laser refractive cataract surgery.

It is imperative that doctors involved in corneal surgery understand the science and clinical application of the four composite map for corneal evaluation in depth. A systematic and step by step guide into interpreting and thus optimizing the use of the four-composite map will improve clinical outcomes and safety for the cataract in refractive surgery.