{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T01:09:20Z","timestamp":1782522560308,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,10,16]],"date-time":"2021-10-16T00:00:00Z","timestamp":1634342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This retrospective cross\u2010sectional study evaluated the potential of an additional biomechanical parameter \u2018E\u2019 as an addition to the tomographic ABCD ectasia\/keratoconus (KC) staging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Corvis Biomechanical Factor (CBiF) represents the modified linear term of the Corvis Biomechanical Index (CBI) developed based on 448 KC corneas from the Homburg Keratoconus Center (HKC). The CBiF range was divided into five stages (E0 to E4) to create a grading system according to the ABCD stages. Stage E0 was characterized by values smaller than the 2.5 percentile. The thresholds were created by dividing the CBiF range between the 2.5 and 97.5 percentiles into four groups of equal values (E1\u2013E4). The frequency distribution of \u2018E\u2019 was analysed and independently validated based on another 860 KC corneas dataset from Milano and Rio de Janeiro (MR). The relationship between \u2018E\u2019 and the ABCD staging was analysed by cross\u2010tabulation. The specificity of \u2018E\u2019 was assessed based on healthy controls (112|851) from both datasets (HKC|MR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>\u2018E\u2019 was normally distributed with E0\u2009=\u200937|30, E1\u2009=\u200986|200, E2\u2009=\u2009155|354, E3\u2009=\u2009101|206, E4\u2009=\u200969|70 in the KC group and 96.4%|90.5% of the controls classified E0 in the HKC|MR dataset, respectively. Cross\u2010tabulation revealed that \u2018E\u2019 was most comparable to posterior corneal curvature (\u2018B\u2019) in both datasets, while showing a trend towards more advanced stages in comparison to anterior corneal curvature (\u2018A\u2019) and thinnest corneal thickness (\u2018C\u2019).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The novel Corvis\u2010derived parameter \u2018E\u2019 provides a biomechanical staging for ectasia\/KC potentially enhancing the ABCD staging and may detect abnormalities before tomographic changes, which requires further studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.15044","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T03:13:45Z","timestamp":1634613225000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Combined biomechanical and tomographic keratoconus staging: Adding a biomechanical parameter to the 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Humanitas University  Milan Italy"},{"name":"Humanitas Clinical and Research Center \u2013 IRCCS  Rozzano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Renato","family":"Ambr\u00f3sio","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Federal University of the State of Rio de Janeiro  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berthold","family":"Seitz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Saarland University Medical Center  Homburg 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