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Purpose <p>The primary aim of this study was to evaluate the morphologic changes of the corneal epithelium by in vivo confocal microscopy (IVCM) in keratoconus patients according to stage, and the secondary aims were to evaluate the subbasal nerve plexus and stroma in addition to the epithelium and to examine whether there were any changes in forme fruste keratoconus (FFKC).</p> Methods <p>In this prospective cross-sectional study, 55 eyes of 55 patients with keratoconus and 30 eyes of 30 healthy subjects (control group) were included. Keratoconus group was divided into stage 1, stage 2, stage 3–4 and FFKC groups according to Amsler Krumeich staging system. Morphologic features of the corneal epithelium in three layers, anterior and posterior stroma keratocyte density, subbasal nerve density and length, dendritic cell density were evaluated.</p> Results <p>In the keratoconus group, the cell area of superficial, intermediate and basal epithelial cells increased in parallel with the stage, while the density and circularity decreased. Anterior and posterior stroma keratocyte densities and total, main and branching nerve fiber density and nerve length parameters were significantly decreased in the keratoconus group compared to the control group. No morphologic difference was observed between the keratoconus group and the FFKC group.</p> Conclusion <p>Progressive epithelial, stromal, and neural microstructural alterations were associated with increasing keratoconus severity, whereas no significant changes were detected in FFKC compared with controls. These findings improve understanding of keratoconus pathophysiology and support the potential value of IVCM in characterizing disease-related microstructural changes.</p>

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Stage-dependent alterations in corneal epithelium, stromal keratocyte density, and subbasal nerve plexus in keratoconus: an in vivo confocal microscopy study

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Tugce Kucukbalci,
  • Betul Seher Uysal,
  • Damla Balaban,
  • Mehmet Cuneyt Ozmen,
  • Mustafa Kamil Bilgihan

摘要

Purpose

The primary aim of this study was to evaluate the morphologic changes of the corneal epithelium by in vivo confocal microscopy (IVCM) in keratoconus patients according to stage, and the secondary aims were to evaluate the subbasal nerve plexus and stroma in addition to the epithelium and to examine whether there were any changes in forme fruste keratoconus (FFKC).

Methods

In this prospective cross-sectional study, 55 eyes of 55 patients with keratoconus and 30 eyes of 30 healthy subjects (control group) were included. Keratoconus group was divided into stage 1, stage 2, stage 3–4 and FFKC groups according to Amsler Krumeich staging system. Morphologic features of the corneal epithelium in three layers, anterior and posterior stroma keratocyte density, subbasal nerve density and length, dendritic cell density were evaluated.

Results

In the keratoconus group, the cell area of superficial, intermediate and basal epithelial cells increased in parallel with the stage, while the density and circularity decreased. Anterior and posterior stroma keratocyte densities and total, main and branching nerve fiber density and nerve length parameters were significantly decreased in the keratoconus group compared to the control group. No morphologic difference was observed between the keratoconus group and the FFKC group.

Conclusion

Progressive epithelial, stromal, and neural microstructural alterations were associated with increasing keratoconus severity, whereas no significant changes were detected in FFKC compared with controls. These findings improve understanding of keratoconus pathophysiology and support the potential value of IVCM in characterizing disease-related microstructural changes.