{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T21:32:06Z","timestamp":1771018326133,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002908","name":"Stichting Combined Ophthalmic Research Rotterdam","doi-asserted-by":"publisher","award":["6.4.0"],"award-info":[{"award-number":["6.4.0"]}],"id":[{"id":"10.13039\/501100002908","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the characteristics of apparently stable forms of tomographically unilateral keratoconus (KC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective case\u2013control study, strict unilaterality criteria were applied to select tomographically unilateral cases with \u22653\u2009years of follow\u2010up. For comparison, a healthy cohort and two bilateral KC cohorts were matched to the tomographically unilateral cases. All patients were selected from The Rotterdam Eye Hospital, whereas healthy controls were selected from the population\u2010based Rotterdam Study. After cohort selection, several risk factors and 25 Pentacam features were assessed. Unaffected (i.e. tomographically non\u2010keratoconic) eyes from the tomographically unilateral cases were compared to matched healthy eyes, matched bilateral KC eyes and affected unilateral KC eyes. Furthermore, affected tomographically unilateral KC eyes were compared to matched bilateral KC eyes. Statistical analysis relied on Wilcoxon signed\u2010rank tests and conditional logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 1006 assessed cases, 18 (1.8%) tomographically unilateral cases were selected. Their median (interquartile range) follow\u2010up was 5.7 (4.3\u20138) years. Eczema and asthma were more prevalent among tomographically unilateral patients (28% each) compared to bilateral patients (6% and 9%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.01 and <jats:italic>p<\/jats:italic>\u2009=\u20090.05, signed\u2010rank test). We could not detect meaningful Pentacam differences between unaffected unilateral eyes and matched healthy eyes. Expectedly, significant differences were detected between unaffected unilateral eyes and affected (bilateral or unilateral) eyes. Lastly, the ectatic features of affected unilateral eyes seemed comparable to their bilateral counterparts, but their high\u2010order aberrations were significantly lower.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings support the existence of tomographically unilateral KC. Understanding how tomographic unilaterality ensues may offer valuable insights into KC aetiology.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.17456","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T05:46:36Z","timestamp":1738907196000},"page":"530-538","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Extremely asymmetric ectasia: Tomographically unilateral keratoconus"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6626-8518","authenticated-orcid":false,"given":"Hasan","family":"Shabani","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Erasmus MC Erasmus University Medical Center  Rotterdam The Netherlands"},{"name":"Department of Epidemiology, Erasmus MC Erasmus University Medical Center  Rotterdam The Netherlands"},{"name":"Cornea Center Rotterdam Eye Hospital  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1780-5281","authenticated-orcid":false,"given":"Wishal D.","family":"Ramdas","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Erasmus MC Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magda A.","family":"Meester\u2010Smoor","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Erasmus MC Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitris","family":"Rizopoulos","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Erasmus MC Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2355-5258","authenticated-orcid":false,"given":"Caroline C. W.","family":"Klaver","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Erasmus MC Erasmus University Medical Center  Rotterdam The Netherlands"},{"name":"Department of Epidemiology, Erasmus MC Erasmus University Medical Center  Rotterdam The Netherlands"},{"name":"Department of Ophthalmology Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart T. H.","family":"van Dooren","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Erasmus MC Erasmus University Medical Center  Rotterdam The Netherlands"},{"name":"Amphia Hospital  Breda The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette J. M.","family":"Geerards","sequence":"additional","affiliation":[{"name":"Cornea Center Rotterdam Eye Hospital  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2022.12.016"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2013.08.014"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/02713683.2015.1082188"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2018.04.006"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfo.2023.03.025"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.jcrs.0000000000000435"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2016.12.015"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000000408"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/08820538.2021.1896752"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0228992"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.18240\/ijo.2021.02.08"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20200212-03"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.03.052"},{"key":"e_1_2_7_15_1","first-page":"e384","article-title":"Unilateral keratoconus: incidence and quantitative topographic analysis","volume":"46","author":"Holland D.R.","year":"1997","journal-title":"Ophthalmology"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781118548387"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-020-00640-5"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000001295"},{"key":"e_1_2_7_19_1","first-page":"1","article-title":"Tomographic Normal values for corneal elevation and Pachymetry in a hyperopic population","volume":"2","author":"Kim T.J.","year":"2011","journal-title":"Journal of Clinical and Experimental Ophthalmology"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-9071.1995.tb00141.x"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2003.06.020"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2023.101840"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2015.12.020"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1152266"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-020-04771-z"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ico.0000178728.57435.df"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICL.0000000000000830"},{"key":"e_1_2_7_28_1","volume-title":"Measurement principle, licences & network","author":"Oculus","year":"2023"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(93)31673-8"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0886-3350(99)00195-9"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.10-5369"},{"key":"e_1_2_7_32_1","first-page":"245","article-title":"Fourteen years follow\u2010up of a stable unilateral Keratoconus: unique case report of clinical, tomographical and biomechanical stability","volume":"22","author":"Saad A.","year":"2022","journal-title":"BioMed Research International"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2021.101559"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-87532-4"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2017.06.031"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2014.06.043"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijo.IJO_2129_19"},{"key":"e_1_2_7_38_1","first-page":"44","article-title":"Comparisons of corneal biomechanical and tomographic parameters among thin normal cornea, forme fruste keratoconus, and mild keratoconus","volume":"8","author":"Tian L.","year":"2021","journal-title":"Eye"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2007.03.001"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.10.028"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/112067210901900102"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-024-01128-2"},{"key":"e_1_2_7_43_1","doi-asserted-by":"crossref","DOI":"10.3390\/bioengineering11050429","article-title":"Diagnosis of Forme Fruste Keratoconus using Corvis ST sequences with digital image correlation and machine learning","volume":"11","author":"Yang L.","year":"2024","journal-title":"Bioengineering"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2015.11.011"}],"container-title":["Acta Ophthalmologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aos.17456","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T10:33:05Z","timestamp":1752834785000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aos.17456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,7]]},"references-count":43,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1111\/aos.17456"],"URL":"https:\/\/doi.org\/10.1111\/aos.17456","archive":["Portico"],"relation":{},"ISSN":["1755-375X","1755-3768"],"issn-type":[{"value":"1755-375X","type":"print"},{"value":"1755-3768","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,7]]},"assertion":[{"value":"2024-10-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}