Corneal endothelial cells change in different stages of keratoconus
https://doi.org/10.21516/2072-0076-2026-19-2-36-42
Abstract
Purpose. To evaluate the changes in morphology and total endothelial count in patients with different stages of keratoconus (KC). Material and methods. A cross-sectional study included 564 eyes of KC patients (57.8% males and 42.2% females) aged 19.9 ± 6.5 years. Study was conducted at the Cornea and Refractive Surgery department of Alshifa trust eye hospital Rawalpindi. Galilei (G4) Dual Scheimpflug Analyzer and specular microscopy (Tomey EM-4000) were used for all eyes examination. KC eyes were classified according to Amsler classification into stage 1, 2 ,3 and 4. Results. There was statistically significant difference in endothelial cell density (p < 0.001) and coefficient of variation (p = 0.001) between different stages of KC eyes. Regarding cell surface area and cell morphology, there was statistically significant difference between different stages of KC eyes (p < 0.001). Conclusions. Significant changes were seen in endothelial cell count and morphology of eyes by using specular microscopy. For stages 1 and 2 KC, these changes are mild but the endothelium in stage 3 and 4 shows significant changes regarding polymegathism and pleomorphism.
Supporting agencies: Authors like to express their gratitude for the general support and encouragement they received during the preparation of this article.
About the Authors
R. S. Bhatti
Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital
Pakistan
Pakistan
Rabia S. Bhatti — Ophthalmic Corneal Surgeon, Department of Cornea and Refractive Surgery.
Rawalpindi, 4600
S. Khan
Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital
Pakistan
Pakistan
Shama Khan — Ophthalmic Corneal Surgeon, Department of Cornea and Refractive Surgery.
Rawalpindi, 4600
H. Mansoor
Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital
Pakistan
Pakistan
Hassan Mansoor — Ophthalmic Corneal Surgeon, Department of Cornea and Refractive Surgery.
Rawalpindi, 4600
A. Maqbool
Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital
Pakistan
Pakistan
Aunaza Maqbool — Pediatric ophthalmologist, Department of Pediatric Ophthalmology.
Rawalpindi, 4600
R. Zafar
Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital
Pakistan
Pakistan
Rabeeah Zafar — Pediatric ophthalmologist, Department of Pediatric Ophthalmology.
Rawalpindi, 4600
R. Faheem
Pakistan Institute of Ophthalmology, Al-Shifa Trust Eye Hospital
Pakistan
Pakistan
Rabia Faheem — Optometrist.
Rawalpindi, 4600
References
1. Singh RB, Koh S, Sharma N, et al. Keratoconus. Nat Rev Dis Primers. 2024; 10: 81. doi: 10.1038/s41572-024-00565-3
2. Rabinowitz YS. Keratoconus. Surv Ophthalmol. 1998; 42 (4): 297–319. doi: 10.1016/S0039-6257(97)00119-7
3. Hashemi H, Heydarian S, Hooshmand E, et al. The prevalence and risk factors for keratoconus: a systematic review and meta-analysis. Cornea. 2020; 39 (2): 263–70. doi: 10.1097/ICO.0000000000002150
4. Sriranganathan A, Chan CC, Dhillon J, Felfeli T. Global incidence and prevalence of keratoconus: a systematic review and meta-analysis. Cornea. 2025. doi: 10.1097/ICO.0000000000003973
5. Gomes JA, Tan D, Rapuano CJ, et al. Global consensus on keratoconus and ectatic diseases. Cornea. 2015; 34 (4): 359–69. doi: 10.1097/ICO.0000000000000408
6. Niazi S, Gatzioufas Z, Doroodgar F, et al. Keratoconus: exploring fundamentals and future perspectives — a comprehensive systematic review. Ther Adv Ophthalmol. 2024; 16. doi: 10.1177/25158414241232258
7. Mathew JH, Goosey JD, Bergmanson JP. Quantified histopathology of the keratoconic cornea. Optom Vis Sci. 2011; 88 (8): 988–97. doi: 10.1097/OPX.0b013e31821f9f1f
8. Galvis V, Sherwin T, Tello A, et al. Keratoconus: an inflammatory disorder? Eye. 2015; 29 (7): 843–59. doi: 10.1038/eye.2015.63
9. Bourne WM. Biology of the corneal endothelium in health and disease. Eye. 2003; 17 (8): 912–8. doi: 10.1038/sj.eye.6700559
10. Laule A, Cable MK, Hoffman CE, Hanna C. Endothelial cell population changes of keratoconus patients. Am J Optom Physiol Opt. 1978; 55 (7): 447–54. doi: 10.1097/00006324-197807000-00001
11. El-Agha MS, El Sayed YM, Harhara RM. Corneal endothelial changes in keratoconus patients. Benha Med J. 2022; 39 (3): 1–8. doi: 10.21608/bmfj.2022.250760
12. Elmassry A, Said DG, Dua HS. Evaluation of corneal endothelial cell changes in keratoconus. Eye Contact Lens. 2021; 47 (6): 345–50. doi: 10.1097/ICL.0000000000000762
13. Reinhart WJ, Musch DC, Jacobs DS, et al. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty: a report by the American Academy of Ophthalmology. Ophthalmology. 2011; 118 (1): 209–18. doi: 10.1016/j.ophtha.2010.11.002
14. Ento Key. Keratoconus classification systems. Available from: https://entokey.com/keratoconus-classification-systems/ [cited 2026 May 21].
15. Shabayek MH, Alio JL. Intrastromal corneal ring segments for keratoconus: clinical outcomes and visual performance. J Cataract Refract Surg. 2007; 33 (7): 1308–14. doi: 10.1016/j.jcrs.2007.03.029
16. Borderie VM, Sandali O, Bullet J, et al. Long-term results of deep anterior lamellar keratoplasty versus penetrating keratoplasty. Ophthalmology. 2012; 119 (2): 249–55. doi: 10.1016/j.ophtha.2011.07.058
17. Jhanji V, Sharma N, Vajpayee RB, et al. Management of keratoconus: current perspective. Br J Ophthalmol. 2011; 95 (8): 1044–50. doi: 10.1136/bjo.2010.190090
18. Galvis V, Sherwin T, Tello A, et al. Keratoconus: an inflammatory disorder? Eye (Lond). 2015; 29: 843–59. doi: 10.1038/eye.2015.63
19. Niederer RL, Perumal D, Sherwin T, et al. Keratoconus and endothelial morphology. Cornea. 2007; 26 (5): 590–6. doi: 10.1097/ICO.0b013e31803bbbdc
20. Hollingsworth JG, Bonshek RE, Efron N, et al. Morphology of corneal endothelium in keratoconus. Eye. 2005; 19: 1162–6. doi: 10.1038/sj.eye.6701732
21. Elmassry A, Said DG, Dua HS, et al. Corneal endothelial cell changes in keratoconus. Eye Contact Lens. 2021; 47 (6): 345–50. doi: 10.1097/ICL.0000000000000762
22. U akhan , zkan M, Kanpolat A, et al. Corneal endothelial changes in keratoconus. Cornea. 2006; 25 (6): 708–13. doi: 10.1097/01.ico.0000227880.64302.8d
23. Matsuda M, Suda T, Manabe R, et al. Corneal endothelial changes in keratoconus. Am J Ophthalmol. 1982; 93 (3): 342–9. doi: 10.1016/0002-9394(82)90327-6
24. Laing RA, Sandstrom MM, Berrospi AR, et al. Morphological changes in keratoconus endothelium. Arch Ophthalmol. 1979; 97 (10): 1865–7. doi: 10.1001/archopht.1979.01020020687011
Review
For citations:
Bhatti R.S., Khan S., Mansoor H., Maqbool A., Zafar R., Faheem R. Corneal endothelial cells change in different stages of keratoconus. Russian Ophthalmological Journal. 2026;19(2):36-42. https://doi.org/10.21516/2072-0076-2026-19-2-36-42
Views:
60
JATS XML
Email this article 