Niazi Sana, Doroodgar Farideh, Pflugfelder Stephen, Bayat Kia, Mohammadi Seyed-Farzad, Mazloomi Maedeh, Alió Del Barrio Jorge L, Moshirfar Majid, Alió Jorge L
Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.
Eye Vis (Lond). 2025 Sep 24;12(1):37. doi: 10.1186/s40662-025-00454-0.
Keratoconus is a progressive corneal ectatic disorder characterized by thinning and irregularity of the cornea, significantly impairing visual acuity. Recent studies have explored how non-ectatic conditions, such as dry eye and tear film instability and alteration of the ocular surface microenvironment, contribute to the development and progression of keratoconus. This comprehensive review aims to investigate the complex relationship between keratoconus and ocular surface diseases by examining the microenvironmental changes that occur on the ocular surface throughout the course of keratoconus, as well as the related clinical implications.
In this PROSPERO-registered study (ID: CRD42025643808), PubMed, Scopus, Cochrane, Embase, Web of Science, and Google Scholar were thoroughly searched to retrieve all pertinent papers published up to January 2025. The retrieved publications were then reviewed, and the eligible ones were included.
Keratoconus, with a similar inflammatory profile to that of ocular surface disease, has elevated Interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and matrix metalloproteinase (MMP)-9, contributing to extracellular matrix degradation and stromal thinning. Tear film instability, altered lipid secretion, and oxidative stress exacerbate disease progression. These findings suggest that keratoconus is not only a biomechanical disorder but also an inflammation-driven one.
This study comprehensively reviews the intricate relationship between the ocular surface microenvironment and keratoconus. Managing this microenvironment in keratoconus patients, as well as inflammation, oxidative stress, and tear film dysfunction, can potentially improve patient outcomes.
圆锥角膜是一种进行性角膜扩张性疾病，其特征是角膜变薄和不规则，严重损害视力。最近的研究探讨了诸如干眼、泪膜不稳定和眼表微环境改变等非扩张性状况如何促进圆锥角膜的发生和发展。本综述旨在通过研究圆锥角膜病程中眼表发生的微环境变化及其相关临床意义，来探究圆锥角膜与眼表疾病之间的复杂关系。
在这项PROSPERO注册研究（ID：CRD42025643808）中，全面检索了PubMed、Scopus、Cochrane、Embase、Web of Science和谷歌学术，以获取截至2025年1月发表的所有相关论文。然后对检索到的出版物进行评审，并纳入符合条件的论文。
圆锥角膜具有与眼表疾病相似的炎症特征，白细胞介素（IL）-1β、IL-6、肿瘤坏死因子（TNF）-α和基质金属蛋白酶（MMP）-9水平升高，导致细胞外基质降解和基质变薄。泪膜不稳定、脂质分泌改变和氧化应激会加剧疾病进展。这些发现表明，圆锥角膜不仅是一种生物力学紊乱疾病，也是一种由炎症驱动的疾病。
本研究全面综述了眼表微环境与圆锥角膜之间的复杂关系。管理圆锥角膜患者的这种微环境以及炎症、氧化应激和泪膜功能障碍，可能会改善患者的预后。
