{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:17:07Z","timestamp":1793229427749,"version":"4.5.0"},"reference-count":64,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T00:00:00Z","timestamp":1584921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Purpose: To review the role of corneal biomechanics for the clinical evaluation of patients with ectatic corneal diseases. Methods: A total of 1295 eyes were included for analysis in this study. The normal healthy group (group N) included one eye randomly selected from 736 patients with healthy corneas, the keratoconus group (group KC) included one eye randomly selected from 321 patients with keratoconus. The 113 nonoperated ectatic eyes from 125 patients with very asymmetric ectasia (group VAE-E), whose fellow eyes presented relatively normal topography (group VAE-NT), were also included. The parameters from corneal tomography and biomechanics were obtained using the Pentacam HR and Corvis ST (Oculus Optikger\u00e4te GmbH, Wetzlar, Germany). The accuracies of the tested variables for distinguishing all cases (KC, VAE-E, and VAE-NT), for detecting clinical ectasia (KC + VAE-E) and for identifying abnormalities among the VAE-NT, were investigated. A comparison was performed considering the areas under the receiver operating characteristic curve (AUC; DeLong\u2019s method). Results: Considering all cases (KC, VAE-E, and VAE-NT), the AUC of the tomographic-biomechanical parameter (TBI) was 0.992, which was statistically higher than all individual parameters (DeLong\u2019s; p &lt; 0.05): PRFI- Pentacam Random Forest Index (0.982), BAD-D- Belin -Ambrosio D value (0.959), CBI -corneal biomechanical index (0.91), and IS Abs- Inferior-superior value (0.91). The AUC of the TBI for detecting clinical ectasia (KC + VAE-E) was 0.999, and this was again statistically higher than all parameters (DeLong\u2019s; p &lt; 0.05): PRFI (0.996), BAD-D (0.995), CBI (0.949), and IS Abs (0.977). Considering the VAE-NT group, the AUC of the TBI was 0.966, which was also statistically higher than all parameters (DeLong\u2019s; p &lt; 0.05): PRFI (0.934), BAD- D (0.834), CBI (0.774), and IS Abs (0.677). Conclusions: Corneal biomechanical data enhances the evaluation of patients with corneal ectasia and meaningfully adds to the multimodal diagnostic armamentarium. The integration of biomechanical data and corneal tomography with artificial intelligence data augments the sensitivity and specificity for screening and enhancing early diagnosis. Besides, corneal biomechanics may be relevant for determining the prognosis and staging the disease.<\/jats:p>","DOI":"10.3390\/ijerph17062113","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T07:16:08Z","timestamp":1585034168000},"page":"2113","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["The Role of Corneal Biomechanics for the Evaluation of Ectasia Patients"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8330-6432","authenticated-orcid":false,"given":"Marcella Q.","family":"Salom\u00e3o","sequence":"first","affiliation":[{"name":"Instituto de Olhos Renato Ambr\u00f3sio, Rio de Janeiro 20520050, Brazil"},{"name":"Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520050, Brazil"},{"name":"Brazilian Study Group of Artificial Intelligence and Corneal Analysis\u2014BrAIN, Rio de Janeiro 20520050, Brazil"},{"name":"Department of Ophthalmology, Federal University of S\u00e3o Paulo, S\u00e3o Paulo 04023062, Brazil"},{"name":"Instituto Benjamin Constant, Rio de Janeiro 22290255, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Luisa","family":"Hofling-Lima","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Federal University of S\u00e3o Paulo, S\u00e3o Paulo 04023062, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise Pellegrino","family":"Gomes Esporcatte","sequence":"additional","affiliation":[{"name":"Instituto de Olhos Renato Ambr\u00f3sio, Rio de Janeiro 20520050, Brazil"},{"name":"Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520050, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8489-3621","authenticated-orcid":false,"given":"Bernardo","family":"Lopes","sequence":"additional","affiliation":[{"name":"Instituto de Olhos Renato Ambr\u00f3sio, Rio de Janeiro 20520050, Brazil"},{"name":"Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520050, Brazil"},{"name":"Department of Ophthalmology, Federal University of S\u00e3o Paulo, S\u00e3o Paulo 04023062, Brazil"},{"name":"School of Engineering, University of Liverpool, L69 3GH Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Vinciguerra","sequence":"additional","affiliation":[{"name":"School of Engineering, University of Liverpool, L69 3GH Liverpool, UK"},{"name":"Humanitas San Pio X Hospital, 20159 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Vinciguerra","sequence":"additional","affiliation":[{"name":"The Eye Center, Humanitas Clinical and Research Center, 20089 Rozzano, Italy"},{"name":"Vincieye Clinic, 20141 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"B\u00fchren","sequence":"additional","affiliation":[{"name":"Praxis f\u00fcr Augenheikunde Prof. B\u00fchren, D-60431 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Nelson","family":"Sena","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Sim\u00f5es","family":"Luz Hilgert","sequence":"additional","affiliation":[{"name":"Hospital da Gamboa, Rio de Janeiro 20220-324, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6919-4606","authenticated-orcid":false,"suffix":"Jr.","given":"Renato","family":"Ambr\u00f3sio","sequence":"additional","affiliation":[{"name":"Instituto de Olhos Renato Ambr\u00f3sio, Rio de Janeiro 20520050, Brazil"},{"name":"Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro 20520050, Brazil"},{"name":"Brazilian Study Group of Artificial Intelligence and Corneal Analysis\u2014BrAIN, Rio de Janeiro 20520050, Brazil"},{"name":"Department of Ophthalmology, Federal University of S\u00e3o Paulo, S\u00e3o Paulo 04023062, Brazil"},{"name":"Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.joco.2016.07.004","article-title":"Corneal biomechanics: Where are we?","volume":"28","author":"Luz","year":"2016","journal-title":"J. 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