[Confocal microscopy of the cornea. Communication 2. Morphological changes in keratoconus]

The paper presents the results of studying morphological changes in keratoconus by life-time confocal microscopy. A total of 50 patients (100 eyes) with grades 1-to-4 keratoconus were examined. The most pronounced changes were found in the corneal areas involved in an ectatic process. Four grades of epitheliopathy were conventionally identified in relation to the desquamation of superficial epitheliocytes, the change of their shape, impaired adhesion with the underlying layers, and transparency disorders. The indirect signs of altered Bowman's membrane were revealed. In early keratocons, the stroma showed hyperreflectivity of anterior layers, higher activated keratocytes, their changed shape and spatial orientation. The emergence of microstrium in the posterior stromal layers with their gradual spread to the midstroma and anterior stroma, abnormal transparency, and scarring were typical of the progress of the disease. There were processes of homogenization and fibrotization of stromal structure and fewer keratocytes. There might be changes in Descemet's membrane (undulating folds) and posterior epithelium (polymegatism, polymorphism, enlarged intercellular spaces, and cell apoptosis). Thus, confocal microscopy reveals certain regularities of a pathological process in keratoconus at different stages of the disease.