Tomographic and densitometric corneal alterations in asymptomatic offspring of patients with keratoconus: a Turkish cross-sectional study.

PURPOSE: To investigate Pentacam HR-derived topographic, topometric, tomographic, and corneal densitometric characteristics in asymptomatic offspring of patients with keratoconus and to determine the prevalence of keratoconus detected during screening in this high-risk population. METHODS: In this cross-sectional study, 56 offspring of patients with keratoconus and 60 age- and sex-matched healthy controls without a family history of keratoconus underwent comprehensive ophthalmic examination and Pentacam HR imaging. Participants diagnosed with keratoconus during screening were excluded from comparative analyses. Topographic, topometric, tomographic, and corneal densitometric parameters were compared between groups. Receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory performance of the examined parameters. RESULTS: Keratoconus was identified in 8 of 56 offspring (14.3%) during screening. After exclusion of these participants, 48 offspring and 60 controls were included in the final analysis. Offspring demonstrated significantly lower thinnest corneal thickness and significantly higher posterior elevation values compared with controls (all p < 0.05). Several Pentacam-derived indices, including ISV, IVA, IHA, IHD, Final D, PPI, and ART measurements, differed significantly between groups (all p < 0.05). Corneal densitometry values were significantly increased in the central 0-2 mm and 2-6 mm zones. Final D showed the highest diagnostic performance among tomographic indices (AUC = 0.862), whereas the anterior 0-2 mm densitometric measurement demonstrated the highest overall discriminative ability (AUC = 0.892). CONCLUSIONS: Offspring of patients with keratoconus represent a high-risk population characterized by an increased prevalence of keratoconus and subtle tomographic, topometric, and densitometric corneal abnormalities despite clinically normal examinations. Pentacam HR-derived tomographic and densitometric parameters may facilitate early identification of individuals with increased ectatic susceptibility.