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Influence of Posterior Corneal Astigmatism on Total Corneal Astigmatism in Eyes With Keratoconus

Savini, Giacomo MD; Næser, Kristian MD; Schiano-Lomoriello, Domenico MD; Mularoni, Alessandro MD

doi: 10.1097/ICO.0000000000000920
Clinical Science

Purpose: To measure posterior corneal astigmatism (PCA) and investigate its influence on total corneal astigmatism (TCA) in eyes with keratoconus.

Methods: Keratometric astigmatism (KA), PCA, and TCA were investigated by means of a dual Scheimpflug analyzer in patients with keratoconus. Vector analysis was carried out with the Næser polar value method.

Results: We enrolled 119 eyes. PCA magnitude averaged 0.77 ± 0.43 diopters (D) and exceeded 0.50, 1.00, and 2.00 D in 73.9%, 21.8%, and 16.8% of eyes, respectively. PCA averaged 0.95 ± 0.48, 0.55 ± 0.28, and 0.70 ± 0.35 D in eyes with with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism. The steepest posterior meridian was oriented vertically (between 61 and 119 degrees) in 55.5% of eyes, thus generating ATR astigmatism. The difference between the location of the steepest meridian of KA and that of TCA was >10 degrees in 8.4% of eyes. On average, KA overestimated TCA in eyes with WTR astigmatism by 0.16 D and underestimated TCA in eyes with ATR astigmatism by 0.22 D. The PCA power oriented along the steeper anterior corneal meridian averaged −0.83 ± 0.40, −0.40 ± 0.37, and −0.53 ± 0.43 D for WTR, ATR, and obliquely astigmatic eyes, respectively. Linear regression disclosed a statistically significant correlation (P < 0.0001, r2 = 0.16) between the meridional powers of TCA and PCA.

Conclusions: In eyes with keratoconus, PCA displays large, variable values and is correlated to TCA. The influence of PCA on TCA cannot be disregarded when planning astigmatism correction by toric intraocular lenses.

Supplemental Digital Content is Available in the Text.

*Fondazione GB Bietti IRCCS, Rome, Italy;

Department of Ophthalmology, Regions Hospital Randers, Randers, Denmark;

Department of Ophthalmology, Ospedale di Stato della Repubblica di San Marino, San Marino; and

§Laservision, Bologna, Italy.

Reprints: Giacomo Savini, MD, Fondazione GB Bietti IRCCS, Via Livenza 3, Rome, Italy (e-mail:

The contribution of GB Bietti IRCCS was supported by Fondazione Roma and the Italian Ministry of Health.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received March 17, 2016

Received in revised form April 17, 2016

Accepted April 28, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.