Corneal endothelial cells changes in different stages of Keratoconus: a multi-Centre clinical study

Ahmed Elmassry,Mai Katkat,Mohamed Elmassry,Mohamed Yousry Hatata,Moataz Sabry,Ahmed Osman,Mohamed El-Kateb

doi:10.1186/s12886-021-01913-7

Abstract

PurposeTo assess the corneal endothelial cells morphology and count in keratoconus patients and their correlation with different stages of keratoconus.MethodsProspective non randomized multi-centric clinical study included 150 eyes of 150 keratoconus patients. Four centers in Egypt participated in this study included: Departments of Ophthalmology in Alexandria University, Tanta University and Port Said University and Alex I-Care hospital. Pentacam (Wavelight Oculyzer II) and specular microscopy (Tomey EM-3000) were done to all eyes. Keratoconic eyes were classified according to Amsler classification into stage 1, 2 and 3. Stage 1 included 99 eyes, stage 2 included 32 eyes & stage 3 included 19 eyes.ResultsThe mean age of keratoconus patients was 24.07 ± 6.154 years. Forty five cases were males (30%) and 105 cases were females (70%). There was statistically significant difference in endothelial cell density (p < 0.001) and coefficient of variation (p = 0.012) between different stages of keratoconus eyes. Regarding cell surface area, there was statistically significant difference in cell surface area between different stages of keratoconus eyes (p < 0.001). In addition, for cell morphology, there was statistically significant difference between different stages of keratoconus eyes (p < 0.001).ConclusionsQualitative and quantitative structural changes were seen in endothelial cells of keratoconus eyes by using specular microscopy. For stages 1 and 2, keratoconus may not affect the corneal endothelim significantly. The endothelium in stage 3 shows significant changes regarding polymegathism and pleomorphism.

Highlights

Keratoconus (KC) is a corneal disorder with a noninflammatory nature
In the present study, we discussed the relation between different stages of keratoconus and endothelial cells changes as regarding the endothelial cell density, coefficient for variation (CV), polymegathism and pleomorphism
Timucin et al [24], Niederer et al [25] and ElAgha et al [26] found no significant difference in Endothelial cell density (ECD) between mild, moderate and severe stages of KC

Summary

Introduction

The reported prevalence is one in 2000 people globally and showed variability among studies [1,2,3,4,5,6,7,8,9,10]. There are variable rates of the progression between individuals and severe stages of the disease are not supposed to occur for everyone. In 10–15% of patients, it may reach for severe stages with required transplantation to get functional vision [1,2,3,4,5,6,7,8,9,10]. Corneal endothelium in humans acts as a one layer of uniformed cells having a hexagonal shape and covers the posterior surface of the cornea. Its function is to stabilize the hydration of corneal and confirm the transparency. Age and pathologies affects the total cells number, regular tessellation, and their size [14]

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