Effect of Down syndrome and keratoconus on corneal density and volume: a triple comparative study

Keratoconus (KCN) and Down syndrome affect the corneal density and volume. In this study included Down syndrome patients with and without KCN (24 Down-KCN and 204 Down-nonKCN eyes) and normal age- and gender-matched individuals (184 eyes). Studied parameters were the corneal density measured with Pentacam HR in 5 concentric zones and annuli (0-2 mm, 2-6 mm, 6-10 mm, 10-12 mm, and 0-12 mm) in 4 different depth layers (anterior 120 µm, posterior 60 µm, middle layer, and the full thickness of the cornea), and the 10 mm zone corneal volume. In Down-KCN, Down-nonKCN, and control groups, respectively, mean full thickness density in the 0-12 mm zone was 19.35 ± 2.92, 17.85 ± 2.55, and 15.78 ± 2.67 GSU, and mean corneal volume was 57.45 ± 4.37, 56.99 ± 3.46, and 61.43 ± 3.42mm³. All density readings were significantly different between the three studied groups (all P < 0.01) except full thickness density in 0-2 mm and 2-6 mm (P > 0.05) and corneal volume (P = 0.519) between Down-KCN and Down-nonKCN groups; these inter-group densitometry differences within the 6 mm zone were only in the middle layer, and not the anterior or posterior thickness layers (all P > 0.05). Corneal density increased with age and corneal thickness, but there was no significant relationship with gender. Overall, Down syndrome is associated with increased density and light scatter in all corneal layers up to the 12 mm diameter. In Down patients with KCN, the increased light scatter and density in the 6 mm zone is only in the middle thickness layer. Corneal volume is reduced in Down syndrome irrespective of the presence or absence of KCN.