Repeatability of Layered Corneal Pachymetry with the Artemis Very High-Frequency Digital Ultrasound Arc-Scanner

Abstract

Purpose: To assess the three-dimensional repeatability of thickness measurements for epithelium, stroma, cornea, flap, and residual stromal bed using the Artemis very high-frequency (VHF) digital ultrasound arc-scanner (ArcScan Inc). Methods: Five consecutive measurements were obtained for 10 eyes of 10 patients 1 year after LASIK using the Artemis VHF digital ultrasound arc-scanner across the central 10-mm diameter of the cornea. Repeatability analysis was performed for thickness measurements for each corneal layer—epithelium, stroma, cornea, flap, and residual stromal bed. The standard deviation of repeated measurements (point-repeatability) was calculated for each measurement location in 0.1-mm steps for the 10×10-mm matrix. The pooled standard deviation of the point-repeatability for each measurement location within the central 1-, 2-, and 3-mm radius was calculated (region-repeatability). The corneal thickness of the baseline scan set was compared to that of subsequent scan sets within the same session and plotted over time to assess any possible hydration effects of the immersion technique. Results: The repeatability at the corneal vertex was 0.58 μ m for epithelium, 1.78 μ m for stroma, 1.68 μ m for cornea, 1.68 μ m for flap, and 2.27 μ m for residual stromal bed. The region-repeatability within the central 1-mm radius was 1.01 μ m for epithelium, 3.44 μ m for stroma, 3.35 μ m for cornea, 2.81 μ m for flap, and 3.97 μ m for residual stromal bed. The mean difference in corneal thickness from the baseline value was within 1.25 μ m for each of the subsequent four scan sets over a 5-minute immersion period. Conclusions: Layered pachymetry of the epithelium, stroma, cornea, flap, and residual stromal bed showed high repeatability with the Artemis VHF digital ultrasound arc-scanner. The high repeatability validates the use of the Artemis for in vivo layered pachymetry.