Purpose To study the relationship between epithelial thickness (ET) and corneal thickness (CT) in healthy fellow eyes of patients with unilateral bullous keratopathy (BKP) and healthy subjects.

Methods Seventeen BKP patients (nine males, eight females, 73.2±10.4 years) and 40 healthy individuals (20 males, 20 females, 69.5±9.8 years) were included. All participants received anterior segment optical coherence tomography and specular microscopy with calculation of endothelial cell density. ET, CT, stromal thickness and ET-to-CT ratio were defined automatically (within 2 mm central area). Central epithelial thickness (CET) and central corneal thickness (CCT) were measured manually at the corneal centre and stromal thickness and CET-to-CCT ratio were calculated.

Results In healthy fellow eyes of BKP patients compared with eyes of healthy individuals ET was statistically significantly lower (p<0.001) while CT was statistically significantly higher (by 28.9 and 30.9 µm in 2 mm zone and corneal centre, respectively). Both 2 mm ET-to-CT ratio (0.091±0.01 and 0.10±0.004, respectively [p<0.001]) and CET-to-CCT ratio (0.083±0.006 and 0.97±0.005, respectively [p<0.0001]) were statistically significantly lower in healthy fellow eyes of BKP patients compared with eyes of healthy individuals. To identify healthy fellow eyes of BKP patients, area under curve for CET-to-CCT ratio and CET was 0.94 and 0.80, respectively (p=0.01), and for 2 mm ET-to-CT ratio and 2 mm ET was 0.91 and 0.80, respectively (p=0.03).

Conclusion Decreased СET-to-СCT ratio resulting from simultaneous epithelial thinning and stromal thickening without significant corneal thickening indicates subclinical dysfunction of corneal endothelium in healthy fellow eyes in unilateral BKP patients.