97th DOG Annual Meeting 1999
SIGNIFICANCE OF CORNEAL TOPOGRAPHY IN PREDICTION OF PATIENT COMPLAINTS FOLLOWING PHOTOREFRACTIVE KERATECTOMY
J. Kampmeier, D. J. Tanzer, H. Er, S. C. Schallhorn, L. LaBree, P. J. McDonnell
Purpose: This study evaluated the sensitivity and specificity of postoperative corneal topography to predict potential patient complaints after photorefractive keratectomy.
Methods: Postoperative tangential corneal topographic maps, in 0.5 and 1.0 diopter relative scales, were obtained from patients (n=34) at least 4 months after photorefractive keratectomy. Topographies of complaining (n=18) and noncomplaining patients (n=16) were analyzed by 6 masked examiners with two different levels of experience in photorefractive keratectomy ("experts": n=2, "beginners": n=4), who assigned the topographies to one of these two groups.
Results: Topographies of complainers (sensitivity) and noncomplainers (specificity) were correctly classified in 53.2% overall and in 44.0% and 63.5% (p=0.06) for complainers and noncomplainers, respectively. Experienced examiners were not significantly more accurate than inexperienced examiners (46.3% vs. 56.6%, respectively, p=0.09). Images of 1 diopter scales received significantly more correct responses than those of 1/2 diopter scales (56.4% vs. 50% respectively, p=0.03). The reproducibility between images for the same subject in both scales was significantly better for the experienced examiners than the inexperienced examiners (kappa coefficient 0.73 and 0.51, respectively, p=0.05).
Conclusions: Subjective analysis of postoperative corneal topography alone is not sufficient to predict potential patient complaints after photorefractive keratectomy. Topographic findings should be interpreted in the context of the complete clinical examination.
Universitäts-Augenklinik Ulm, Prittwitzstr. 43, D-89075 Ulm /
Doheny Eye Institute and Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles, USA