Assessment of Anterior, Posterior, and Total Central Corneal Astigmatism in Eyes With Keratoconus

PurposeTo investigate the magnitudes and the axis orientations of anterior, posterior, and total central corneal astigmatism in eyes with keratoconus.DesignRetrospective case series.MethodsThis study comprised 137 eyes of 137 keratoconic patients (97 men and 40 women; mean age ± standard deviation, 36.9 ± 12.2 years). The magnitude and the axis orientation of each corneal astigmatism were determined with a rotating Scheimpflug system.ResultsThe mean magnitudes of anterior, posterior, and total central corneal astigmatism were 3.93 ± 2.74 diopters (D), 0.93 ± 0.64 D, and 3.90 ± 2.75 D, respectively. With-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism of the anterior corneal surface was found in 90 eyes (65.7%), 33 eyes (24.1%), and 14 eyes (10.2%), respectively, whereas the corresponding astigmatism of the posterior corneal surface was found in 14 eyes (10.2%), 15 eyes (10.9%), and 108 eyes (78.8%), respectively. We found a significant correlation between the magnitudes of anterior and posterior corneal astigmatism (Pearson correlation coefficient r = 0.769, P < .001).ConclusionsThe mean magnitudes of anterior and posterior corneal astigmatism were approximately 4 D and 1 D, respectively, in eyes with keratoconus. Approximately 65% and 80% of eyes showed that WTR anterior astigmatism and ATR posterior astigmatism, respectively. The presence of posterior corneal astigmatism is not necessarily negligible for the accurate astigmatic correction of toric intraocular lens implantation or rigid gas-permeable contact lens wear for keratoconus.