Laser Scanning In Vivo Confocal Analysis of Keratocyte Density in Keratoconus

Ku, Judy Y.F.; Niederer, Rachael L; Patel, Dipika V.; Sherwin, Trevor; McGhee, Charles N J

doi:10.1016/j.ophtha.2007.04.067

Cited by 105 publications

(77 citation statements)

References 19 publications

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“…This finding was supported by Ucakhan et al, who reported the presence of Vogt's striae in the anterior stroma of keratoconic eyes with moderate and severe (3)(4)(5)(6)22). In the present study, polymegathism and pleomorphism were higher in patients with keratoconus than in those with healthy eyes.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Corneal Cell Morphology in Keratoconus: A Confocal Microscopic Observation

Ghosh¹,

Mutalib²,

Kaur³

et al. 2017

MJMS

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Purpose: To evaluate corneal cell morphology in patients with keratoconus using an in vivo slit scanning confocal microscope.Methods: A cross-sectional study was conducted to evaluate the corneal cell morphology of 47 keratoconus patients and 32 healthy eyes without any ocular disease. New keratoconus patients with different disease severities and without any other ocular co-morbidity were recruited from the ophthalmology department of a public hospital in Malaysia from June 2013 to May 2014. Corneal cell morphology was evaluated using an in vivo slit-scanning confocal microscope. Qualitative and quantitative data were analysed using a grading scale and the Nidek Advanced Visual Information System software, respectively.Results: The corneal cell morphology of patients with keratoconus was significantly different from that of healthy eyes except in endothelial cell density (P = 0.072). In the keratoconus group, increased level of stromal haze, alterations such as the elongation of keratocyte nuclei and clustering of cells at the anterior stroma, and dark bands in the posterior stroma were observed with increased severity of the disease. The mean anterior and posterior stromal keratocyte densities and cell areas among the different stages of keratoconus were significantly different (P < 0.001 and P = 0.044, respectively). However, the changes observed in the endothelium were not significantly different (P > 0.05) among the three stages of keratoconus.Conclusion: Confocal microscopy observation showed significant changes in corneal cell morphology in keratoconic cornea from normal healthy cornea. Analysis also showed significant changes in different severities of keratoconus. Understanding the corneal cell morphology changes in keratoconus may help in the long-term monitoring and management of keratoconus.

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Section: Discussionsupporting

confidence: 90%

“…A semi-automated method was used to analyse the stromal keratocyte. The keratocyte nuclei were marked manually using the 'L' method to calculate the cell area and density (6,10). The fully automated method was used to analyse the endothelium.…”

Section: Confocal Microscopymentioning

confidence: 99%

Corneal Cell Morphology in Keratoconus: A Confocal Microscopic Observation

Ghosh¹,

Mutalib²,

Kaur³

et al. 2017

MJMS

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“…In vivo confocal microscope (IVCM) which provides cellular level resolution en face images of the cornea has also been commonly used in studying KC corneas. 12,13 Previous studies using IVCM have shown changes in the density of epithelial cells 13,14 and stromal keratocytes 14,15 in KC corneas. Increased haze/scatter in all the corneal layers 13,16 has also been observed in the KC eyes.…”

Section: Introductionmentioning

confidence: 96%

Epithelium and Bowman’s layer thickness and light scatter in keratoconic cornea evaluated using ultrahigh resolution optical coherence tomography

et al. 2012

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Abstract. A custom-developed ultrahigh resolution optical coherence tomography with an axial resolution of 1.1 μm in corneal tissue was used to characterize thickness and light scatter of the epithelium and Bowman's layer in keratoconic (KC) cornea noninvasively. A 4-mm wide vertical corneal section around the apex in nine KC and eight normal eyes was imaged in vivo. The epithelium and Bowman's layer were visualized and their thickness profiles were quantified. Scatter was quantified based on the sensitivity normalized mean signal intensity distribution. Average mean thickness of the epithelium and Bowman's layer in KC eyes was significantly smaller ðp < 0.05Þ than the normal eyes. The epithelium thickness variation across a central 3-mm cornea was significantly larger in KC eyes than in normal eyes. The scatter in KC eyes was significantly increased only for Bowman's layer. The changes observed in this study could improve our understanding of the underlying disease mechanism of KC and can provide new indications for early disease diagnosis.

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“…Indeed, IVCM has demonstrated alterations to all layers of the cornea in keratoconus with a particular reduction in density of the sub-basal nerve plexus and stromal keratocytes [13][14][15] . Plus, IVCM has proven to be highly convenient for microstructural analysis of the cornea after C-CXL 16 .…”

Section: Introductionmentioning

confidence: 99%

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

Bouheraoua

Jouve

Borderie

et al. 2015

JoVE

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Keratoconus is a bilateral and progressive corneal ectasia. In order to slow down its progression, corneal collagen cross-linking (CXL) has recently been introduced as an efficient treatment option. In biological and chemical sciences, crosslinking refers to new chemical bonds formed between reactive molecules. Hence, the aim of corneal collagen CXL is to synthetically increase the formation of crosslinks between collagen fibrils in the corneal stroma. Despite the fact that the efficiency of the conventional CXL (C-CXL) protocol has already been shown in several clinical studies, it might benefit from improvements in duration of the procedure and removal of corneal epithelium. Hence, in order to provide a coherent evaluation of two new and optimized CXL protocols, we studied keratoconus patients who had undergone one of the three CXL treatments: iontophoresis (I-CXL), accelerated CXL (A-CXL), and conventional CXL (C-CXL). A-CXL is a 6 time faster CXL procedure using a ten time higher UVA irradiance but still including an epithelium removal. Iontophoresis is a transepithelial non-invasive technique in which a small electric current is applied to improve riboflavin penetration throughout the cornea. Using anterior segment optical coherence tomography (AS OCT) and in vivo confocal microscopy (IVCM), we conclude that regarding the depth of treatment penetration, conventional CXL protocol remains the standard for treating progressive keratoconus. Accelerated CXL seems to be a quick, effective and safe alternative to treat thin corneas. The use of iontophoresis is still being investigated and should be considered with greater caution. Video LinkThe video component of this article can be found at

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Laser Scanning In Vivo Confocal Analysis of Keratocyte Density in Keratoconus

Cited by 105 publications

References 19 publications

Corneal Cell Morphology in Keratoconus: A Confocal Microscopic Observation

Corneal Cell Morphology in Keratoconus: A Confocal Microscopic Observation

Epithelium and Bowman’s layer thickness and light scatter in keratoconic cornea evaluated using ultrahigh resolution optical coherence tomography

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

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