Authors
Virgilio Galvis, María F García, Verónica Storino, Sergio E Serrano, Alejandro Tello
Published in
Cornea. Aug 21, 2026. Epub Aug 21, 2026.
Abstract
To identify determinants of posterior corneal astigmatism (PCA) orientation, including anterior corneal astigmatism (ACA) orientation and magnitude.
In this retropective cross-sectional observational study, anonymized swept-source optical coherence tomography biometry measurements (IOLMaster 700) were analyzed. Eyes with previous refractive surgery, corneal ectasia, or ocular trauma were excluded. ACA and PCA were classified as with-the-rule, against-the-rule (ATR), or oblique according to the steepest meridian, accounting for the optical reversal of the posterior cornea. Associations with ATR PCA were evaluated using chi-square tests and regression models.
A total of 17,860 eyes from 17,860 patients were included. Among 17,483 eyes with PCA > 0 D and classifiable orientation, 14,335 (81.99%) had ATR PCA. In bivariate analysis, each additional year of age was associated with lower odds of ATR PCA (odds ratio: 0.955; P < 0.001). ATR PCA was present in 9096 eyes (92.85%) with with-the-rule or oblique ACA versus 4960 eyes (67.19%) with ATR ACA (P < 0.001). Among eyes with ATR ACA ≥ 3.00 D, only 14 of 213 (6.57%) exhibited ATR PCA (unadjusted odds ratio: 0.007; P < 0.001). Male sex remained independently associated with lower odds of ATR PCA.
ACA orientation and magnitude were strongly associated with PCA orientation. Age showed a marked bivariate association, although its independent contribution was attenuated after multivariable adjustment. High-magnitude ATR ACA identified eyes in which PCA often departed from the predominant ATR pattern.
PMID:
42644735
Bibliographic data and abstract were imported from PubMed on 26 Aug 2026.
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