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Endothelial alterations in 712 keratoconus patients
Author(s) -
Goebels Susanne,
Eppig Timo,
Seitz Berthold,
Szentmàry Nòra,
Cayless Alan,
Langenbucher Achim
Publication year - 2018
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13471
Subject(s) - keratoconus , scheimpflug principle , ophthalmology , medicine , corneal endothelium , endothelium , cornea
Purpose To investigate the effect of the severity of keratoconus on the corneal endothelium using specular microscopy. Methods Seven hundred and twelve eyes from the Homburg Keratoconus Center ( HKC ) database were included in this retrospective study. Corneal endothelium was evaluated using the Tomey EM ‐3000 specular microscope. Keratoconus‐related topographic and tomographic data were obtained from Scheimpflug‐based tomography (Oculus Pentacam ® HR ). Eyes were classified into stages 0 (healthy) to 4 (severe keratoconus) according to the Topographic Keratoconus Classification ( TKC ). Subgroups were analysed based on contact lens ( CL ) type (none/rigid/soft). Results The frequencies of keratoconus stages 0/1/2/3/4 according to TKC were 169/94/206/166/77. The endothelial cell density ( ECD ) for the endothelial cell area for TKC 0/1/2/3/4 was 2611/2624/2557/2487/2401 cells per mm² and the coefficient of variation ( CV ) was 40.9/40.0/41.6/46.2/49.0%, respectively. The more severe the keratoconus stage, the lower the endothelial cell count (p < 0.001) and the higher the CV (p < 0.001). No contact lens wearing was noted in 207 eyes (No CL ), rigid CL in 200 ( RCL ) and soft CL in 54 ( SCL ). CD for No CL / RCL / SCL was 2523/2533/2644 per mm² and CV was 41.8/54.1/43.1%, respectively. A significant difference in CV was found between No CL and RCL (p = 0.02), and no significant difference in CV was found between No CL and SCL (p = 0.07). Endothelial cell density (ECD) did not differ significantly between No CL and RCL or SCL . Conclusion Endothelial cell density (ECD) decreases and CV increases significantly with increasing tomographic severity of keratoconus. In patients with RCL compared to eyes without CL wear, we found a statistically significantly higher CV in the endothelial cell size.