Three-Dimensional Scanning Electron Microscopic Study of Keratoconus Corneas

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Abstract
KERATOCONUS is a noninflammatory disease characterized by thinning and scarring of the central portion of the cornea.1 Histopathologic and ultrastructural studies have demonstrated that in early stages of the disease, fragmentation of the epithelial basement membrane occurs with disintegration of the Bowman layer and fibrillation of the anterior stroma.2-5 The central cornea then becomes thinned, with destruction of the Bowman layer and stromal scarring. A loss of collagen lamellae occurs, but the collagen fibrils are of normal diameter.6,7 The lamellae are surrounded by granular materials, which are shown to be rich in neutral polysaccharides and glycoproteins.1,4 In advanced stages of the disease, the central portion of the Descemet membrane may rupture, resulting in acute hydrops.