The human corneal endothelium in keratoconus: A specular microscopic study

Area of Science:

• Ophthalmology
• Corneal Science
• Cell Biology

Background:

• Keratoconus is a progressive thinning and ectasia of the cornea.
• The corneal endothelium plays a crucial role in maintaining corneal clarity and hydration.
• Understanding endothelial cell morphology in keratoconus is vital for disease progression insights.

Purpose of the Study:

• To investigate the morphological characteristics of the corneal endothelium in keratoconus patients.
• To identify any alterations in endothelial cell size, shape, and distribution associated with keratoconus.

Main Methods:

• Clinical specular microscopy was employed to examine the corneal endothelium.
• Twelve cases of keratoconus were included in the study.
• Detailed analysis of endothelial cell pleomorphism, size variation, and orientation was performed.

Main Results:

• Increased cellular pleomorphism was observed, with numerous smaller-than-normal endothelial cells.
• A population of large, elongated endothelial cells was noted, with their long axes oriented towards the corneal apex.
• The cornea with acute hydrops showed a localized area of significantly enlarged endothelial cells (7-10 times normal size).

Conclusions:

• Keratoconus is associated with significant changes in corneal endothelial cell morphology, including stretching and altered orientation.
• The findings suggest that endothelial cell alterations may be a consequence of the ectatic process in keratoconus.
• Localized endothelial cell enlargement in acute hydrops supports the hypothesis of a defect and subsequent compensatory cell growth.