International Ophthalmology

, Volume 37, Issue 4, pp 1017–1024 | Cite as

Biomechanical evaluation of cornea in patients with ankylosing spondylitis

  • Mehtap Caglayan
  • Ozge Sarac
  • Pinar Kosekahya
  • Sukran Erten
  • Berna Ayan
  • Nurullah Cagil
Original Paper



The aim of this study was to evaluate the corneal biomechanical parameters in patients with ankylosing spondylitis (AS) and to compare them with the healthy subjects.


Sixty patients with AS (study group) and 60 healthy subjects (control group) were enrolled in this prospective study. The study group was further classified as active (n:30) and inactive (n:30). After detailed ophthalmological examination including intraocular pressure (IOP) measurement with Goldmann applanation tonometer (IOPGAT), corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Reichert Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was measured with the Spectral-Domain Optical Coherence Tomography (SD-OCT).


The study group’s mean CH, CCT, IOPg, and IOPGAT values were lower than the control group (p < 0.05 for all variables). The mean CH, CRF, CCT, IOPg, and IOPGAT values were higher in active patients when compared to the inactive ones (p < 0.001, p < 0.001, p = 0.013, p = 0.021, and p = 0.002, respectively).


AS patients have lower CCT, CH, IOPg, and IOPGAT when compared with healthy subjects. In the active stage of AS, patients present with higher levels of corneal biomechanical parameters with thicker corneas. IOPcc is a more accurate measurement than IOPGAT or IOPg in AS patients.


Ankylosing spondylitis Central corneal thickness Corneal hysteresis Corneal resistance factor 


Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.


  1. 1.
    Maksymowych WP (2003) Spondyloartropathies: etiology and pathogenesis of ankylosing spondylitis. In: Hochberg M, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (eds) Rheumatology. Elsevier, Philadelphia, pp 1183–1192Google Scholar
  2. 2.
    Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390CrossRefPubMedGoogle Scholar
  3. 3.
    Gouveia EB, Elmann D, Morales MS (2012) Ankylosing spondylitis and uveitis: overview. Rev Bras Reumatol 2012(52):742–756Google Scholar
  4. 4.
    Pato E, Munoz-Fernández S, Francisco F et al (2011) Uveitis working group from Spanish society of rheumatology. Semin Arthritis Rheum 40:314–323CrossRefPubMedGoogle Scholar
  5. 5.
    Linder R, Hoffmann A, Brunner R (2004) Prevalence of the spondyloarthritides in patients with uveitis. J Rheumatol 31:2226–2229PubMedGoogle Scholar
  6. 6.
    Monnet D, Breban M, Hudry C et al (2004) Ophthalmic findings and frequency of extraocular manifestations in patients with HLAB27 uveitis: a study of 175 cases. Ophthalmology 111:802–809CrossRefPubMedGoogle Scholar
  7. 7.
    Leal C, Le Roux K, Rahmi A et al (2014) Scleritis, clinical features, etiologies and treatment: a case series of 32 patients. Rev Med Interne 35:491–497 (Article in French) CrossRefPubMedGoogle Scholar
  8. 8.
    Patel SJ, Lundy DC (2002) Ocular manifestations of autoimmune disease. Am Fam Physician 66:991–998PubMedGoogle Scholar
  9. 9.
    Kotech A (2007) What biomechanical properties of the cornea are relevant fort he clinician? Surv Ophthalmol 52:109–114CrossRefGoogle Scholar
  10. 10.
    Fratzl P, Daxer A (1993) Structural transformation of collogen fibrils in corneal stroma during drying. An x-ray scattering study. Biophys J 64:1210–1214CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Prata TS, Sousa AK, Garcia Filho CAA et al (2009) Assessment of corneal biomechanical properties and intraocular pressure in patients with rheumatoid arthritis. Can J Ophthalmol 44:602CrossRefPubMedGoogle Scholar
  12. 12.
    Taş M, Öner V, Özkaya E et al (2014) Evaluation of corneal biomechanical properties in patients with rheumatoid arthritis: a study by ocular response analyzer. Ocul Immunol Inflamm 22:224–227CrossRefPubMedGoogle Scholar
  13. 13.
    Can ME, Erten S, Can GD et al (2015) Corneal biomechanical properties in rheumatoid arthritis. Eye Contact Lens 41:1–4CrossRefGoogle Scholar
  14. 14.
    Yazici AT, Kara N, Yüksel K et al (2011) The biomechanical properties of the cornea in patients with systemic lupus erythematosus. Eye (Lond) 25:1005–1009CrossRefGoogle Scholar
  15. 15.
    Emre S, Kayikcioglu O, Ates H et al (2010) Corneal hysteresis, corneal resistance factor, and intraocular pressure measurement in patients with scleroderma using the reichert ocular response analyzer. Cornea 29:628–631CrossRefPubMedGoogle Scholar
  16. 16.
    Van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis, a proposal for modification of the New York criteria. Arthritis Rheum 27:361–368CrossRefPubMedGoogle Scholar
  17. 17.
    Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity ındex. J Rheumatol 21:2286–2291PubMedGoogle Scholar
  18. 18.
    Daikh D, Chen PP (2014) Advances in managing ankylosing spondylitis. F1000 Prime Rep 6:78CrossRefGoogle Scholar
  19. 19.
    Sieper J, Braun J, Rudwaleit M et al (2002) Ankylosing spondylitis: an overview. Ann Rheum Dis 61:8–18CrossRefGoogle Scholar
  20. 20.
    Kelley WN (1985) Textbook of rheumatology. W.B.Saundes, Philadelphia, pp 432–511Google Scholar
  21. 21.
    Kim TJ, Kim TH (2010) Clinical spectrum of ankylosing spondylitis in Korea. Joint Bone Spine 77:235–240CrossRefPubMedGoogle Scholar
  22. 22.
    Ji SX, Yin XL, Yuan RD et al (2012) Clinical features of ankylosing spondylitis associated with acute anterior uveitis in Chinese patients. Int J Ophthalmol 5:164–166PubMedPubMedCentralGoogle Scholar
  23. 23.
    Shah S, Laiquzzaman M, Cunliffe I et al (2006) The use of the Reichert ocular response analyser to establish the relationship between ocular hysteresis, corneal resistance factor and central corneal thickness in normal eyes. Cont Lens Anterior Eye 29:257–262CrossRefPubMedGoogle Scholar
  24. 24.
    Ortiz D, Pinero D, Shabayek MH et al (2007) Corneal biomechanical properties in normal, post-laser in situ keratomileusis and keratoconic eyes. J Cataract Refract Surg 33:1371–1375CrossRefPubMedGoogle Scholar
  25. 25.
    Kirvan C, O’keefe M, Lanigan B (2006) Corneal hysteresis and intraocular pressure measurement in children using the reichert ocular response analyzer. Am J Ophthalmol 142:990–992CrossRefGoogle Scholar
  26. 26.
    Herndon LW (2006) Measuring intraocular pressure-adjustment for corneal thickness and new technologies. Curr Opin Ophthalmology 17:115–119CrossRefGoogle Scholar
  27. 27.
    Fontes BM, Ambrósio R Jr, Jardim D et al (2010) Corneal biomechanical metrics and anterior segment parameters in mild keratoconus. Ophthalmology 117:673–679CrossRefPubMedGoogle Scholar
  28. 28.
    Goldich Y, Barkana Y, Gerber Y et al (2009) Effect of diabetes mellitus on biomechanical parameters of the cornea. J Cataract Refract Surg 35:715–719CrossRefPubMedGoogle Scholar
  29. 29.
    Brandt JD (2004) Corneal thickness in glaucoma screening, diagnosis, and management. Curr Opin Ophthalmol 15:85–89CrossRefPubMedGoogle Scholar
  30. 30.
    Özcura F, Aktaş S, Özkan Y et al (2016) Central corneal thickness and corneal curvature in patients with rheumatoid arthritis. Int Ophthalmol. doi: 10.1007/s10792-016-0243-2 Google Scholar
  31. 31.
    Ortak H, Inanir A, Demir S et al (2014) Decreased central corneal thickness in ankylosing spondylitis. Int Ophthalmol 34:263–268CrossRefPubMedGoogle Scholar
  32. 32.
    Gunes A, Erkol Inal E, Tok L et al (2015) Assessment of corneal parameters with scheimpflug imaging in patients with ankylosing spondylitis. Semin Ophthalmol 4:1–5Google Scholar
  33. 33.
    Marsovszky L, Németh J, Resch MD et al (2014) Corneal langerhans cell and dry eye examinations in ankylosing spondylitis. Innate Immun 20:471–477CrossRefPubMedGoogle Scholar
  34. 34.
    Villani E, Viola F, Sala R et al (2010) Corneal involvement in Graves’ orbitopathy: an in vivo confocal study. Invest Ophthalmol Vis Sci 51:4574–4578CrossRefPubMedGoogle Scholar
  35. 35.
    Benitez del castillo JM, Wasfy MAS, Fernandez C et al (2004) An in vivo confocal masked study on corneal epithelium and subbasal nerves in patients with dry eye. Invest Ophthalmol Vis Sci 45:3030–3035CrossRefPubMedGoogle Scholar
  36. 36.
    Wakamatsu TH, Sato EA, Matsumoto Y et al (2010) Conjunctival in vivo confocal scanning laser microscopy in patients with Sjogren syndrome. Invest Ophthalmol Vis Sci 51:144–150CrossRefPubMedGoogle Scholar
  37. 37.
    Tuominen IS, Konttinen YT, Vesaluoma MH et al (2003) Corneal innervation and morphology in primary Sjögren’s syndrome. Invest Ophthalmol Vis Sci 44:2545–2549CrossRefPubMedGoogle Scholar
  38. 38.
    Liu R, Chu RY, Wang L et al (2008) The measured value of corneal hysteresis and resistance factor with their related factors analysis in normal eyes. Zhonghua Yan Ke Za Zhi 44:715–719PubMedGoogle Scholar
  39. 39.
    Sedaghat MR, Sharepoor M, Hassanzadeh S et al (2012) The corneal volume and biomechanical corneal factors: is there any correlation? J Res Med Sci 17:32–39PubMedPubMedCentralGoogle Scholar
  40. 40.
    Yildirim KA, Erdal A, Karatay S et al (2004) Relationship between some acute phase reactants and the bath ankylosing spondylitis disease activity index in patients with ankylosing spondylitis. South Med J 97:350–353CrossRefPubMedGoogle Scholar
  41. 41.
    Inal EE, Eroglu P, Sunar I et al (2014) May we use enthesitis indices in evaluating disease activity in patients with ankylosing spondylitis? Acta Medica Mediterranea 30:1305–1310Google Scholar
  42. 42.
    Claushuis TA, De Vries MK, Van der Weijden MA et al (2015) Crusius, C-reactive protein polymorphisms influence serum CRP-levels independent of disease activity in ankylosing spondylitis. Clin Exp Rheumatol 33:159–165PubMedGoogle Scholar
  43. 43.
    Cankaya C, Kalayci BN (2014) Corneal biomechanical characteristics in patients with behcet disease. Semin Ophthalmol 13:1–7CrossRefGoogle Scholar
  44. 44.
    Altinkaynak H, Duru N, Ersoy R et al (2015) Topographic and biomechanical evaluation of cornea in patients with acromegaly. Cornea 34:65–70CrossRefPubMedGoogle Scholar
  45. 45.
    Tuzcu EA, Ustun N, Ilhan N et al (2014) Peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layers thickness in ankylosing spondylitis. Ocul Immunol Inflamm 22:429–433CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Mehtap Caglayan
    • 1
  • Ozge Sarac
    • 1
  • Pinar Kosekahya
    • 2
  • Sukran Erten
    • 3
  • Berna Ayan
    • 1
  • Nurullah Cagil
    • 4
  1. 1.Ophthalmology DepartmentAtaturk Research and Training HospitalAnkaraTurkey
  2. 2.Ulucanlar Eye Research and Training HospitalAnkaraTurkey
  3. 3.Rheumatology Department, Atatürk Research and Training HospitalYildirim Beyazit UniversityAnkaraTurkey
  4. 4.Ophthalmology Department, Atatürk Research and Training HospitalYildirim Beyazit UniversityAnkaraTurkey

Personalised recommendations