Quantitative analysis of corneal microstructure in keratoconus utilising in vivo confocal microscopy

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Abstract
To establish and quantify the in vivoconfocal microscopic features of moderate to advanced keratoconus. Nineteen keratoconus subjects were catergorised using Orbscan-derived corneal apex power and pachymetry as exhibiting moderate (n=7) and advanced (n=12) keratoconus. Control subjects included 23 noncontact lens wearers (Group A) and 15 contact lens wearers (Group B). All subjects underwent Confoscan slit scanning in vivoconfocal microscopy. Compared with Group A (4912±434 cells/mm2), basal epithelial density was significantly lower in both moderate (4592±414 cells/mm2, P2, P=0.01). In comparison to Group A (761±118 cells/mm2), anterior stroma keratocyte density was significantly greater in both moderate keratoconus (883±111 cells/mm2, P=0.001) and advanced keratoconus (952±122 cells/mm2, P2) posterior stroma keratocyte density was also significantly greater in advanced keratoconus (599±97 cells/mm2, PPper se, was associated with significantly reduced (P=0.000) keratocyte density in the anterior stroma (609±66 cells/mm2) and demonstrated a trend (P=0.056) in the posterior stroma (470±63 cells/mm2). Keratoconic corneas (429±72 μm) were significantly thinner than control Groups A (508±77 mm) and B (495±80 μm). The presence of keratoconus did not affect the endothelial cell density (P=0.54). In vivoconfocal microscopy can provide insight into the microstructural changes that occur in keratoconus.