{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T17:57:07Z","timestamp":1789840627420,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T00:00:00Z","timestamp":1631232000000},"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":["Clinical Exper Ophthalmology"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To assess alterations in backscatter from the corneal epithelium, anterior stroma and lens surface in eyes with subclinical, mild and moderate keratoconus (KC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this single\u2010centre, cross\u2010sectional study involving 24 eyes with subclinical KC, 107 eyes with manifest KC (mild\u00a0=\u00a040 and moderate\u00a0=\u00a067 eyes) and 90 controls, line densitometry was performed with Pentacam (Oculus Optikger\u00e4te GmbH, Wetzlar, Germany) to obtain simultaneous backscatter values for the corneal epithelium, anterior stroma and anterior lens surface. Backscatter values and Pentacam parameters were used in subsequent statistical analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eyes with subclinical, mild and moderate KC had similar epithelial and stromal backscatter (<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05) that was significantly increased compared with the controls (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Although anterior lens surface backscatter did not differ between the control and KC groups (<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05), it was significantly higher in the mild and moderate KC groups than in the subclinical KC group (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). In the KC group (n\u00a0=\u00a0131) epithelial backscatter was strongly correlated with stromal backscatter (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.911<jats:italic>, P<\/jats:italic>\u2009&lt;\u20090.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increased epithelial backscatter and a strong correlation with anterior stromal backscatter in the KC groups were consistent with the epithelium\u2010stroma interaction involved in KC pathogenesis. Single\u2010point backscatter analysis can be used with point clouds to construct epithelial and stromal backscatter maps in Pentacam to aid the detection of KC as a novel feature.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ceo.13996","type":"journal-article","created":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T03:39:06Z","timestamp":1630553946000},"page":"1000-1008","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Increased epithelial backscatter: A novel finding in subclinical and clinical keratoconus"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6325-7485","authenticated-orcid":false,"given":"Ibrahim","family":"Toprak","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine Pamukkale University  Denizli Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celal Emre","family":"Gunes","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine Pamukkale University  Denizli Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,10]]},"reference":[{"key":"e_1_2_7_2_1","article-title":"Ectatic diseases","volume":"108347","author":"Salom\u00e3o MQ","year":"2020","journal-title":"Exp Eye Res"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/APO.0000000000000334"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/APO.0000000000000332"},{"key":"e_1_2_7_5_1","article-title":"Genetics vs chronic corneal mechanical trauma in the etiology of keratoconus","volume":"108328","author":"Rabinowitz YS","year":"2020","journal-title":"Exp Eye Res"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2013.262"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000000266"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00347-018-0667-3"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.exer.2010.06.021"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000002458"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.5301\/ejo.5000644"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20200212-03"},{"key":"e_1_2_7_13_1","first-page":"2537","article-title":"Baseline findings in the collaborative longitudinal evaluation of keratoconus (CLEK) study","volume":"39","author":"Zadnik K","year":"1998","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20090610-06"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20151021-02"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000002435"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2018.06.020"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e318030df5a"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000002334"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.3928\/1081597X-20150820-07"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-77138-3"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-019-01026-0"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003226-199501000-00013"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-18480-x"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-9071.2004.00805.x"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0184628"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/aos.14433"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0000000000001537"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10792-020-01605-z"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1167\/tvst.8.3.12"}],"container-title":["Clinical &amp; 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