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Purpose: This study aimed to investigate the actual changes of centralcorneal thickness (CCT) in keratoconus and normal corneas during air puffindentation, by using corneal visualization Scheimpflug technology (Corvis ST).Methods: A total of 32 keratoconic eyes and 46 normal eyes were included inthis study. Three parameters of CCTinitial, CCTfinal and CCTpeak were selectedto represent the CCT at initial time, final time and highest corneal concavity,respectively, during air puff indentation. Wilcoxon signed rank test (pairedsample test) was used to assess the differences between these 3 parameters inboth keratoconus and normal groups. Univariate linear regression analysis wasperformed to determine the effect of CCTinitial on CCTpeak and CCTfinal, aswell as the impact of air puff force on CCT in each group. Receiver operatingcharacteristic (ROC) curves were constructed to evaluate the discriminativeability of the 3 parameters. Results: The results demonstrated that CCTpeak andCCTfinal were significantly decreased (p<0.01) compared to CCTinitial in bothkeratoconus and normal groups. Regression analysis indicated a significantpositive correlation between CCTpeak and CCTinitial in normal cornea group(R2=0.337, p<0.01), but not in keratoconus group (R2=0.029, p=0.187). Likewise,regression models of air puff force and CCT revealed the different patterns ofCCT changes between keratoconus and normal cornea groups. Furthermore, ROCcurves showed that CCTpeak exhibited the greatest AUC (area under ROC curve) of0.940, with accuracy, sensitivity and specificity of 94.9%, 87.5% and 100%,respectively. Conclusions: CCT may change during air puff indentation, and issignificantly different between keratoconus and normal cornea groups. Thechanging pattern is useful for the diagnosis of keratoconus, and lays thefoundation for corneal biomechanics.

Evaluation of central corneal thickness in keratoconus and normal corneas during air puff indentation