Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany.
Department of Experimental Ophthalmology, Saarland University, Homburg, Germany.
Acta Ophthalmol. 2018 Mar;96(2):e134-e139. doi: 10.1111/aos.13471. Epub 2017 Jun 9.
To investigate the effect of the severity of keratoconus on the corneal endothelium using specular microscopy.
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).
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 (NoCL), rigid CL in 200 (RCL) and soft CL in 54 (SCL). CD for NoCL/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 NoCL and RCL (p = 0.02), and no significant difference in CV was found between NoCL and SCL (p = 0.07). Endothelial cell density (ECD) did not differ significantly between NoCL and RCL or SCL.
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.
使用共焦显微镜研究圆锥角膜严重程度对角膜内皮的影响。
本回顾性研究纳入了来自霍姆堡圆锥角膜中心（HKC）数据库的 712 只眼。使用 Tomey EM-3000 共焦显微镜评估角膜内皮。从基于 Scheimpflug 的断层扫描（Oculus Pentacam HR）获得与圆锥角膜相关的地形和断层数据。根据地形圆锥角膜分类（TKC），将眼睛分为 0 期（健康）至 4 期（严重圆锥角膜）。根据接触镜（CL）类型（无/硬性/软性）对亚组进行分析。
根据 TKC，圆锥角膜 0/1/2/3/4 期的频率分别为 169/94/206/166/77。TKC 0/1/2/3/4 的内皮细胞密度（ECD）分别为 2611/2624/2557/2487/2401 个细胞/平方毫米，变异系数（CV）分别为 40.9/40.0/41.6/46.2/49.0%。圆锥角膜程度越严重，内皮细胞计数越低（p<0.001），CV 越高（p<0.001）。207 只眼（无 CL）未佩戴接触镜，200 只眼（硬性 CL）佩戴硬性 CL，54 只眼（软性 CL）佩戴软性 CL。无 CL/RCL/SCL 的 CD 分别为 2523/2533/2644 个细胞/平方毫米，CV 分别为 41.8/54.1/43.1%。无 CL 和 RCL 之间的 CV 存在显著差异（p=0.02），无 CL 和 SCL 之间的 CV 无显著差异（p=0.07）。无 CL 和 RCL 之间的内皮细胞密度（ECD）无显著差异。
随着圆锥角膜断层严重程度的增加，角膜内皮细胞密度（ECD）显著降低，CV 显著增加。与不戴 CL 的眼睛相比，在佩戴硬性 CL 的患者中，我们发现内皮细胞大小的 CV 存在统计学上的显著差异。
