{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:33:49Z","timestamp":1792805629675,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,8,17]],"date-time":"2015-08-17T00:00:00Z","timestamp":1439769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Core-Vision Research Grant","award":["P30 EY007551"],"award-info":[{"award-number":["P30 EY007551"]}]},{"name":"The Uppsala university\/Uppsala County ALF"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to identify ultrastructural changes associated with ectasia and to determine the association between lamellar count and corneal thinning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five surgically removed keratoconic corneal buttons and four, non\u2010keratoconic, normal eye bank control corneas were processed for transmission electron microscopy using an established protocol, ensuring minimal tissue distortion. A sequence of overlapping digital images, spanning the full apical cone corneal thickness, was assembled. A seamless digital montage was printed at 5000\u00d7 magnification. Lamellae were counted in the anterior\u2013posterior orientation, along a linear line, using established criteria for identification of individual lamellae.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The stromal thickness estimated as a 95% confidence interval for the mean, CI (0.95), in the keratoconic corneas was 372\u00a0\u00b1 62\u00a0\u03bcm, while in the normal cornea, it was 446\u00a0\u00b1\u00a089\u00a0\u03bcm. All keratoconic corneas showed ultrastructural evidence of lamellar splitting and a loss of interweaving anterior lamellae. In the keratoconic corneas, the median total linear stromal lamellar absolute count tangential to the corneal surface was 362, (25th percentile; 75th percentile)\u00a0=\u00a0(355; 365) lamellae and in the normal cornea, 246, (25th percentile; 75th percentile)\u00a0=\u00a0(239; 251). The linear lamellar density in the keratoconic corneas was estimated as CI (0.95) 117\u00a0\u00b1\u00a022 and 86\u00a0\u00b119 lamellae per 100\u00a0\u03bcm in the anterior and posterior portion of the stroma, respectively. In normal cornea, the linear lamellar density was estimated as CI (0.95) 51\u00a0\u00b1\u00a08 and 80\u00a0\u00b1\u00a020 lamellae per 100\u00a0\u03bcm. The mean difference of linear lamellar count between the anterior and the posterior portion of the cornea was estimated as CI (0.95) 31\u00a0\u00b1\u00a023 for keratoconic corneas and \u221229\u00a0\u00b1\u00a028 for the normal corneas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current morphometric analysis of ultrastructural changes suggests that ectasia and thinning in keratoconus is associated with lamellar splitting into multiple bundles of collagen fibrils and loss of anterior lamellae. These structural changes, possibly in addition to lateral shifting of lamellae due to the pressure gradient over the cornea, are a potential explanation to the central loss of mass.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.12811","type":"journal-article","created":{"date-parts":[[2015,8,17]],"date-time":"2015-08-17T12:07:40Z","timestamp":1439813260000},"page":"767-773","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Lamellar changes in the keratoconic cornea"],"prefix":"10.1111","volume":"93","author":[{"given":"Jessica H.","family":"Mathew","sequence":"first","affiliation":[{"name":"Texas Eye Research and Technology Center University of Houston College of Optometry Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Goosey","sequence":"additional","affiliation":[{"name":"Texas Eye Research and Technology Center University of Houston College of Optometry Houston Texas USA"},{"name":"Houston Eye Associates Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per G.","family":"S\u00f6derberg","sequence":"additional","affiliation":[{"name":"Department of Neuroscience Gullstrand Lab, Ophthalmology Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan P. 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