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Keratoconus: an ocular manifestation of systemic immune dysregulation?

Burhan Başkan1, Yusuf Evcimen1

  • 1Department of Ophthalmology, SBU Van Training and Research Hospital, Van, Turkey.

Expert Review of Clinical Immunology
|May 28, 2026
PubMed

Insights

This study found a significant link between keratoconus and immune-mediated diseases like rheumatoid arthritis and asthma in Eastern Anatolia. These findings suggest a potential role for the immune system in keratoconus development.

Area of Science:

  • Ophthalmology
  • Immunology
  • Epidemiology

Background:

  • Keratoconus, a corneal ectatic disorder, is traditionally viewed as non-inflammatory.
  • Emerging evidence suggests a potential role for immune system involvement in keratoconus pathogenesis.
  • This study investigates the epidemiological connection between keratoconus and immune-mediated diseases.

Purpose of the Study:

  • To evaluate the association between keratoconus and various immune-mediated diseases.
  • To assess the prevalence of specific immune diseases in a keratoconus cohort compared to controls.
  • To explore the relationship between keratoconus severity and immune disease prevalence.

Main Methods:

  • Retrospective cohort study including 642 keratoconus patients and 2568 age-sex-matched controls.
  • Prevalence of rheumatoid arthritis, ulcerative colitis, Crohn's disease, Hashimoto's thyroiditis, autoimmune hepatitis, asthma, allergic rhinitis, and atopic dermatitis was compared.
  • Logistic regression analysis adjusted for age, sex, BMI, and smoking status, with Bonferroni correction applied.

Main Results:

  • A higher prevalence of any immune-mediated disease was observed in keratoconus patients (38.6%) compared to controls (21.2%).
  • Significant associations, post-Bonferroni correction, were found for rheumatoid arthritis, asthma, allergic rhinitis, and autoimmune hepatitis.
  • Immune disease prevalence demonstrated an increase with keratoconus severity.

Conclusions:

  • Strong epidemiological associations suggest immunological mechanisms may contribute to keratoconus pathogenesis.
  • The study highlights potential links between keratoconus and specific immune-mediated conditions.
  • Further prospective studies are required to establish causality and validate these associations.
Abstract

Keywords:
Eastern AnatoliaKeratoconusallergyautoimmunityepidemiologyimmunopathogenesis

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