{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:18:27Z","timestamp":1792189107094,"version":"4.4.0"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,6,9]],"date-time":"2017-06-09T00:00:00Z","timestamp":1496966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the effect of the severity of keratoconus on the corneal endothelium using specular microscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seven hundred and twelve eyes from the Homburg Keratoconus Center (<jats:styled-content style=\"fixed-case\">HKC<\/jats:styled-content>) database were included in this retrospective study. Corneal endothelium was evaluated using the Tomey <jats:styled-content style=\"fixed-case\">EM<\/jats:styled-content>\u20103000 specular microscope. Keratoconus\u2010related topographic and tomographic data were obtained from Scheimpflug\u2010based tomography (Oculus Pentacam<jats:sup>\u00ae<\/jats:sup> <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>). Eyes were classified into stages 0 (healthy) to 4 (severe keratoconus) according to the Topographic Keratoconus Classification (<jats:styled-content style=\"fixed-case\">TKC<\/jats:styled-content>). Subgroups were analysed based on contact lens (<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>) type (none\/rigid\/soft).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The frequencies of keratoconus stages 0\/1\/2\/3\/4 according to <jats:styled-content style=\"fixed-case\">TKC<\/jats:styled-content> were 169\/94\/206\/166\/77. The endothelial cell density (<jats:styled-content style=\"fixed-case\">ECD<\/jats:styled-content>) for the endothelial cell area for <jats:styled-content style=\"fixed-case\">TKC<\/jats:styled-content> 0\/1\/2\/3\/4 was 2611\/2624\/2557\/2487\/2401 cells per mm\u00b2 and the coefficient of variation (<jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content>) was 40.9\/40.0\/41.6\/46.2\/49.0%, respectively. The more severe the keratoconus stage, the lower the endothelial cell count (p\u00a0&lt;\u00a00.001) and the higher the CV (p\u00a0&lt;\u00a00.001). No contact lens wearing was noted in 207 eyes (No<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>), rigid <jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content> in 200 (<jats:styled-content style=\"fixed-case\">RCL<\/jats:styled-content>) and soft <jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content> in 54 (<jats:styled-content style=\"fixed-case\">SCL<\/jats:styled-content>). <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content> for No<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">RCL<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">SCL<\/jats:styled-content> was 2523\/2533\/2644 per mm\u00b2 and <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> was 41.8\/54.1\/43.1%, respectively. A significant difference in <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> was found between No<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">RCL<\/jats:styled-content> (p\u00a0=\u00a00.02), and no significant difference in <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> was found between No<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">SCL<\/jats:styled-content> (p\u00a0=\u00a00.07). Endothelial cell density (ECD) did not differ significantly between No<jats:styled-content style=\"fixed-case\">CL<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">RCL<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">SCL<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Endothelial cell density (ECD) decreases and CV increases significantly with increasing tomographic severity of keratoconus. In patients with RCL compared to eyes without CL wear, we found a statistically significantly higher CV in the endothelial cell size.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.13471","type":"journal-article","created":{"date-parts":[[2017,6,9]],"date-time":"2017-06-09T07:26:09Z","timestamp":1496993169000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Endothelial alterations in 712 keratoconus patients"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4791-2184","authenticated-orcid":false,"given":"Susanne","family":"Goebels","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Saarland University Medical Center Homburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0661-6239","authenticated-orcid":false,"given":"Timo","family":"Eppig","sequence":"additional","affiliation":[{"name":"Department of 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