A correlation study between a corneal endothelial count in patients with different stages of keratoconus using specular microscopy

Gomes, Beatriz de Abreu Fiuza; Lobo, Georgia Veloso Parente

doi:10.5935/0034-7280.20210020

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ORIGINAL ARTICLE • Rev. bras.oftalmol. 80 (2) • Mar-Apr 2021 • https://doi.org/10.5935/0034-7280.20210020 copy

A correlation study between a corneal endothelial count in patients with different stages of keratoconus using specular microscopy

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the corneal endothelial count in patients with keratoconus (KCN) by specular microscopy and correlate with the stage of keratoconus.

Methods:

Ninety-three eyes from 61 patients with KCN were included in this cross-sectional study. The eyes were classified into KCN stages 1 to 4 according to the Amsler-Krumeich classification using keratometry obtained by corneal topography and pachymetry readings obtained by specular microscopy.

Results:

Age ranged from 12 to 43 years, mean ± (standard deviation) 22.1 ± 6.7 years. The average keratometry ranged from 42.25 to 71.4 D, (53.0 ± 6.1 D). Pachymetry ranged from 350 to 606 µm, (461.7 ± 47.1 µm). Regarding the Amsler classification, 23 patients (24.7%) had stage 1, 24 (25.8%) stage 2, 5 (6.5%) stage 3 and 41 patients (44.1%) stage 4. No linear correlation was observed between mean keratometry and endothelial cell count (Pearson's correlation coefficient = -0.05). In the early to moderate stages of KCN, the mean endothelial cell count was 2738.3 ± 285.4 cell / mm2, while in the advanced KCN group (stages 3 and 4) it was 2670.6 ± 262.7 cell / mm2 , p = 0.24.

Conclusions:

No correlation was found between the endothelial cell count and the KCN stage.

Keywords:
Corneal endothelium; Keratoconus; Specular microscopy; Endothelial cell density; Keratometry

	Current study	Uçakhan et al.⁽¹⁴14 Uçakhan OO, Kanpolat A, Ylmaz N, Ozkan M. In vivo confocal microscopy findings in keratoconus. Eye Contact Lens. 2006;32(4):183-91.⁾	Niederer et al.⁽¹¹11 Niederer RL, Perumal D, Sherwin T, McGhee CN. Cont Lens Anterior Eye. 2013;36:80-85. Laser scanning in vivo confocal microscopy reveals reduced innervation and reduction in cell density in all layers of the keratoconic cornea. Invest Ophthalmol Vis Sci. 2008;49(7):2964-70.⁾	Timucin et al.⁽⁶6 Timucin OB, Karadag MF, Cinal A, Asker M, Asker S, Timucin D. Assessment of corneal endothelial cell density in patients with keratoconus not using contact lenses. Cont Lens Anterior Eye. 201336(2):80-5.⁾	El-Agha et al.⁽¹⁰10 El-Agha MS, El Sayed YM, Harhara RM, Essam HM. Correlation of corneal endothelial changes with different stages of keratoconus. Cornea. 2014;33(7):707-11.⁾	Goebels et al.⁽¹³13 Goebels S, Eppig T, Seitz B, Szentmàry N, Cayless A, Langenbucher A. Endothelial alterations in 712 keratoconus patients. Acta Ophthalmol. 2018;96(2):e134-9.⁾
Sample Size with KCN (eyes)	93	48	52	65	90	712
Age (mean) in years	22	22,8	27,9	20,9	27	38
Adopted Classification	Asmler-Krumeich Stage 1: 24,7% Stage 2: 25,8% Stage 3: 0,5% Stage 4: 44,1%	Main Keratometry Mild (<47D) 10,4% Moderate (47-55D) 35,4% Severe (>55D) 54,2%	Greater Keratometry Mild (<45D) / Moderate (45-52D): 40.3% Severe (>52D) 61.5%	Greater Keratometry Mild (<45D) 29.2% Moderate (45-52D): 32.3% Severe (>52D): 38.4%	Asmler-Krumeich Stage 1: 27.5% Stage 2: 42.5% Stage 3: 30% Not observed: Stage 4	Amsler-Krumeich Stage 0 23.7% Stage 1: 13.2% Stage 2: 28.9% Stage 3: 23.3% Stage 4: 10.8%
Endothelial cell count (mean) cells/mm² based on stage	Initial and moderate 2738,3 Severe (stages 3 and 4): 2670,6	Not mentioned	Mild/Moderate: 2510,6 Severo: 2345,5	Mild: 2759 Moderate: 2747 Severe: 2698	Stage 1: 2404.5 Stage 2: 2455,4 Stage 3: 2214,8	Stage 0: 2611 Stage 1: 2624 Stage 2: 2557 Stage 3: 2487 Stage 4: 2401
Conclusion	No relationship was found between KCN stages and EC	There was significant difference in EC when it was compared to severe KCN, with mild to moderate KCN (p <0.05)	There was no significant difference in EC between KCN stages	There was no significant difference in EC between KCN stages	Significant difference in EC, at stage 3 with lower EC (p <0.05)	Significant difference in EC, at stage 3 with lower EC (p <0.05)
KCN = keratoconus; EC = endothelial cell count

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[1] Corresponding author Beatriz de Abreu Fiuza Gomes e-mail: beatriz.exopina@gmail.com