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Ultrastructural study of peripheral and central stroma of keratoconus cornea
  1. Aljoharah Alkanaan, PhD Student1,
  2. Robert Barsotti, Professor2,
  3. Omar Kirat, Consultant3,
  4. Turki Almubrad, Professor1,
  5. Adnan Khan, Researcher1,
  6. Saeed Akhtar1
  1. 1 Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
  2. 2 Department of Biomedical Science, Salus University, Philadelphia, Pennsylvania, USA
  3. 3 Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
  1. Correspondence to Professor Saeed Akhtar, Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, PO Box 10219, Riyadh 11433, Saudi Arabia; akhtars{at}


Purpose Assess the lamellar organisation of the peripheral and central stroma of the keratoconus (KC) and normal cornea.

Methods Five normal and three KC corneas were fixed in 2.5% glutaraldehyde and processed for electron microscopy. The ultrathin sections were observed under JEOL 1400 TEM, and digital images were taken with a bottom-mounted 11-megapixel Quamisa camera, using the iTEM software. Measurements of the lamellae were carried out using the iTEM software. Statistical analysis was performed using the SPSS software.

Results The lamellar organisation at the centre and periphery of the KC cornea was disrupted by the presence of multiple undulations, which were more aggressive at the posterior stroma. Among the KC cornea, the mean lamellar thickness of the peripheral middle (1030.32±86.25 nm) and posterior (615.68±30.94 nm) stroma was also significantly (p<0.05) thinner than their corresponding areas of the central KC cornea (1151.1±48 nm; 783.57±31.10 nm). At the periphery of KC cornea, just above the Descemet’s membrane (DM), small undulations appeared to emerge out from the DM. Furthermore, the anterior stroma of the peripheral cornea contained several lamellar sutures. The mean lamellar thickness of the peripheral and central KC cornea was significantly (p<0.0001) thinner than the corresponding areas of the normal cornea.

Conclusion The present study reveals the involvement of lamellae in the peripheral stroma in the pathogenicity of the KC cornea. The emergence of small undulations in the DM suggests that the formation of undulation might be starting from the DM.

  • Keratoconus
  • Cornea
  • Lamellae
  • Stroma
  • Descemet’s membrane

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  • Contributors AA and SA hypothesised and designed the experiments. AA, AK, SA and TA performed the experiments. AA, OK, TA, AK and SA analysed the data. AA, AK and SA contributed reagents/materials/analysis tools. AA, RB, OK, TA and SA prepared the manuscript. All the authors reviewed the manuscript and provided intellectual input for finalising discussion and interpretation of data.

  • Funding This work was supportedby the Deanship of Scientific Research at King Saud University for funding thisresearch (Research Project) grantnumber ‘RGP – VPP – 219’.

  • Competing interests None declared.

  • Patient consent Tissue used were anonymous.

  • Ethics approval Ethical Committee of King Saud University, Ethics Number: CAMS 19-36/37.

  • Provenance and peer review Not commissioned; externally peer reviewed.