Corneal higher-order aberrations in phlyctenular keratitis

Purpose: To characterize tomographic patterns and quantify corneal higher-order aberrations (HOAs) in eyes with corneal scar due to phlyctenular keratitis. Study design: Retrospective consecutive case series. Methods: This study included 51 eyes of 38 patients (24 women; 14 men) with corneal scar due to phlyctenular keratitis. HOAs of the total cornea, and of the anterior and posterior surfaces were measured using anterior segment optical coherence tomography (AS-OCT). Corneal tomographic patterns were classified into five types: increased regular astigmatism, ectasia, asymmetric, flattening and minimal change patterns. The correlation between corneal HOAs and visual acuity was evaluated. Results: Mean months from onset was 50.7 ± 74.7 and mean number of recurrences 2.1 ± 1.1 (1–5). Mean logarithm of the minimal angle of resolution (logMAR) was 0.19 ± 0.31. AS-OCT showed ectasia pattern in 16 eyes (31.4%), asymmetric pattern in 12 eyes (23.5%), increased regular astigmatism pattern in 9 eyes (17.6%), flattening pattern in 3 eyes (5.9%) and minimal change pattern in 11 eyes (21.6%). HOAs of the total cornea were 0.57 ± 0.44 μm and 1.16 ± 0.77 μm within a 4-mm and 6-mm diameter, significantly larger than in normal controls (P < 0.0001). LogMAR visual acuity was significantly correlated with corneal HOAs (4-mm: r = 0.558, P < 0.0001, 6-mm: r = 0.566, P < 0.0001), central corneal thickness (r = − 0.349, P = 0.016), and corneal astigmatism (r = 0.414, P = 0.004), but not with average keratometric value (r = − 0.092, P = 0.537). Conclusions: The most common tomographic pattern was ectasia, followed by a asymmetric pattern in eyes with phlyctenular keratitis. Corneal HOAs were associated with decreased visual acuity in phlyctenular keratitis patients.