Corneal Imaging | Topography, Tomography, Anterior Segment OCT & Confocal Microscopy

In this session, we take walkthrough of corneal imaging, focusing on topography, tomography, and how to interpret the Pentacam’s four refractive maps. The session also covers anterior segment OCT and confocal microscopy, with real clinical insights into how these investigations are used in clinical practice.

Key themes include:
⭐ Differences between topography (anterior surface only) and tomography (full corneal shape including posterior surface + pachymetry).
⭐ How and when to use topography — contact lens fitting, IOL calculations, and basic anterior curvature assessment.
⭐ How tomography works, particularly the Pentacam: posterior curvature, corneal thickness distribution, and elevation mapping.
⭐ A step-by-step, systematic method for assessing Pentacam scans — patient details, quality score, K readings, axial curvature, pachymetry map, and anterior/posterior elevation.
⭐ Recognising patterns of keratoconus: inferior steepening, focal thinning, and high anterior/posterior elevation values.
⭐ Classic signs of pellucid marginal degeneration — the crab-claw pattern and inferior band thinning.
⭐ Understanding regular vs irregular astigmatism, with-the-rule vs against-the-rule, and implications for toric IOL suitability.
⭐ Identifying post-LASIK patterns and the relevance for later cataract surgery biometry.
⭐ Uses of anterior segment OCT: corneal scars, graft assessment, angles in glaucoma, and pre-operative planning.
⭐ Confocal microscopy highlights: diagnosing acanthamoeba via cysts, fungal patterns, and use in dystrophies and graft follow-up.

Take-home messages:
🌟 Tomography gives far more information than topography — learn to read all four Pentacam maps systematically.
🌟 Inferior steepening + focal thinning + high elevation values are hallmarks of keratoconus.
🌟 Irregular astigmatism is a red flag for toric IOL unsuitability.
🌟 Post-refractive surgery corneas need modified biometry — always check their tomography first.
🌟 Use anterior segment OCT and confocal microscopy when clinical examination alone isn’t enough.

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