{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:36:47Z","timestamp":1788781007445,"version":"build-2803163510"},"reference-count":36,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Global Surgical Service S.L.","award":["CPI-23-155"],"award-info":[{"award-number":["CPI-23-155"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Purpose: To evaluate the relationship between choroidal thickness (CT) and anterior scleral thickness (AST) in patients with subclinical keratoconus (SKC) and established keratoconus (KC). Methods: This single-center prospective case-control study included 97 eyes of 97 patients: 44 KC eyes, 14 SKC eyes, and 39 age- and axial length (AL)-matched healthy eyes. Using swept-source optical coherence tomography, the AST was manually measured in four directions and the CT was obtained automatically from the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Principal component analysis (PCA) was used to linearly reduce the dimensionality of nine CT inputs to one significant component, CT1. A multivariate model was created to evaluate the association between CT1, AST, and several ocular parameters in SKC and KC patients. Partial correlation was then performed to adjust the confounding factors and to examine the effect of AST on CT1. Results: The PCA showed that CT1 accounts for 86.54% of the total variance in the nine original CTs of the ETDRS grid. The CT1 model was associated with age, AL, and AST in the superior meridian in SKC eyes, whereas in KC eyes, it was correlated with gender, age, AL, and AST in the inferior meridian (p &lt; 0.001). The partial correlation between CT1 and AST in the superior zone was found to be significant, positive, and strong in SKC eyes (r = 0.79, p = 0.019), whereas a significant, positive, and moderate correlation between CT1 and AST at the inferior zone (r = 0.41, p = 0.017) was observed in KC eyes. Conclusions: Choroidal tissue was significantly correlated with the anterior sclera across the vertical meridian. This relationship was observed over the superior sclera in SKC eyes, whereas in established KC, it was over the inferior sclera. These results reveal new insights regarding the interactions between the anterior and posterior structures of the KC eyes and confirm the enigma of the pathophysiology of KC.<\/jats:p>","DOI":"10.3390\/diagnostics14202280","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T05:47:58Z","timestamp":1728884878000},"page":"2280","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Relationship between Choroidal Thickness and Anterior Scleral Thickness in Patients with Keratoconus"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0508-1431","authenticated-orcid":false,"given":"Neus","family":"Burguera-Gim\u00e9nez","sequence":"first","affiliation":[{"name":"Anterior Segment, Cornea and External Eye Diseases Unit, Fundaci\u00f3n de Oftalmolog\u00eda M\u00e9dica (FOM), Av. P\u00edo Baroja, 12, E-46015 Valencia, Spain"},{"name":"Department of Optics, Optometry and Vision Sciences, Physics School, University of Valencia, Dr. Moliner, 50, E-46100 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8146-4039","authenticated-orcid":false,"given":"M.\u00aa Amparo","family":"D\u00edez-Ajenjo","sequence":"additional","affiliation":[{"name":"Anterior Segment, Cornea and External Eye Diseases Unit, Fundaci\u00f3n de Oftalmolog\u00eda M\u00e9dica (FOM), Av. P\u00edo Baroja, 12, E-46015 Valencia, Spain"},{"name":"Department of Optics, Optometry and Vision Sciences, Physics School, University of Valencia, Dr. Moliner, 50, E-46100 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9363-5482","authenticated-orcid":false,"given":"Celeste","family":"Briceno-Lopez","sequence":"additional","affiliation":[{"name":"Anterior Segment, Cornea and External Eye Diseases Unit, Fundaci\u00f3n de Oftalmolog\u00eda M\u00e9dica (FOM), Av. P\u00edo Baroja, 12, E-46015 Valencia, Spain"},{"name":"Department of Optics, Optometry and Vision Sciences, Physics School, University of Valencia, Dr. Moliner, 50, E-46100 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noem\u00ed","family":"Burguera","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Q Vision, Vithas Virgen del Mar Hospital, Ctra. el Mami a Viator, Km.1, E-04120 Almer\u00eda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5918-8429","authenticated-orcid":false,"given":"M.\u00aa Jos\u00e9","family":"Luque-Cobija","sequence":"additional","affiliation":[{"name":"Department of Optics, Optometry and Vision Sciences, Physics School, University of Valencia, Dr. Moliner, 50, E-46100 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Peris-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Anterior Segment, Cornea and External Eye Diseases Unit, Fundaci\u00f3n de Oftalmolog\u00eda M\u00e9dica (FOM), Av. P\u00edo Baroja, 12, E-46015 Valencia, Spain"},{"name":"Surgery Department, Ophthalmology, School of Medicine, University of Valencia, Av. Blasco Ib\u00e1\u00f1ez, 15, E-46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0039-6257(97)00119-7","article-title":"Keratoconus","volume":"42","author":"Rabinowitz","year":"1998","journal-title":"Surv. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ajo.2016.12.015","article-title":"Age-specific incidence and prevalence of keratoconus: A nationwide registration study","volume":"175","author":"Godefrooij","year":"2017","journal-title":"Am. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1038\/eye.2015.63","article-title":"Keratoconus: An inflammatory disorder?","volume":"29","author":"Galvis","year":"2015","journal-title":"Eye"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jtos.2020.03.006","article-title":"The keratoconus enigma: A review with emphasis on pathogenesis","volume":"18","author":"Ferrari","year":"2020","journal-title":"Ocul. Surf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8592","DOI":"10.1167\/iovs.11-7732","article-title":"Oxidative stress in keratoconus?","volume":"52","author":"Arnal","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1111\/aos.14714","article-title":"Oxidative and antioxidative stress markers in keratoconus: A systematic review and meta-analysis","volume":"99","author":"Navel","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/ICO.0000000000002150","article-title":"The prevalence and risk factors for keratoconus: A systematic review and meta-analysis","volume":"39","author":"Hashemi","year":"2020","journal-title":"Cornea"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.survophthal.2017.06.009","article-title":"A review of keratoconus: Diagnosis, pathophysiology, and genetics","volume":"62","author":"MacGregor","year":"2017","journal-title":"Surv. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.clae.2018.05.005","article-title":"Differences in corneo-scleral topographic profile between healthy and keratoconus corneas","volume":"42","author":"Carracedo","year":"2019","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101343","DOI":"10.1016\/j.clae.2020.06.001","article-title":"The corneoscleral shape in keratoconus patients with and without specialty lens wear","volume":"44","author":"Consejo","year":"2021","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_11","first-page":"17","article-title":"Clinical and morphological aspects of the state of the sclera in various types of genetically determined corneal changes","volume":"108","author":"Kopaeva","year":"1992","journal-title":"Vestn. Oftalmol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Burguera-Gim\u00e9nez, N., D\u00edez-Ajenjo, M.A., Burguera, N., and Peris-Mart\u00ednez, C. (2023). Anterior scleral thickness profile in keratoconus. Life, 13.","DOI":"10.3390\/life13112223"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1159\/000350801","article-title":"Assessment of the macula in keratoconus: An optical coherence tomography and multifocal electroretinography study","volume":"229","author":"Moschos","year":"2013","journal-title":"Ophthalmologica"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jtos.2021.12.004","article-title":"The link between keratoconus and posterior segment parameters: An updated, comprehensive review","volume":"23","author":"Hashemi","year":"2022","journal-title":"Ocul. Surf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4274\/tjo.galenos.2020.84748","article-title":"The relationship between keratoconus stage and the thickness of the retinal layers","volume":"51","year":"2021","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s40123-023-00858-y","article-title":"Subfoveal and parafoveal choroidal thickening in patients with keratoconus using the ETDRS grid on swept-source OCT","volume":"13","author":"Burguera","year":"2024","journal-title":"Ophthalmol. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"100773","DOI":"10.1016\/j.preteyeres.2019.100773","article-title":"Scleral structure and biomechanics","volume":"74","author":"Boote","year":"2020","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.preteyeres.2009.12.002","article-title":"The multifunctional choroid","volume":"29","author":"Nickla","year":"2010","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"101366","DOI":"10.1016\/j.clae.2020.08.010","article-title":"Scleral shape and its correlation with corneal parameters in keratoconus","volume":"44","author":"Dhaese","year":"2020","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_20","first-page":"8816449","article-title":"Keratoconus with Central Serous Chorioretinopathy: A Rare Combination","volume":"2020","author":"Tsiogka","year":"2020","journal-title":"Case Rep. Ophthalmol. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"213","DOI":"10.3109\/02713683.2014.952828","article-title":"Effects of sex and age on the normal retinal and choroidal structures on optical coherence tomography","volume":"40","author":"Ooto","year":"2015","journal-title":"Curr. Eye Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Read, S.A., Alonso-Caneiro, D., Vincent, S.J., Bremner, A., Fothergill, A., Ismail, B., McGraw, R., Quirk, C.J., and Wrigley, E. (2016). Anterior eye tissue morphology: Scleral and conjunctival thickness in children and young adults. Sci. Rep., 6.","DOI":"10.1038\/srep33796"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.ajo.2012.07.015","article-title":"The relationship between axial length and choroidal thickness in eyes with high myopia","volume":"155","author":"Lugo","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1159\/000512396","article-title":"Anterior scleral thickness in myopic eyes and its association with ocular parameters","volume":"64","author":"Sung","year":"2021","journal-title":"Ophthalmic Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.2147\/OPTH.S301330","article-title":"The role of atopy in the choroidal profile of keratoconus patients","volume":"15","author":"Moleiro","year":"2021","journal-title":"Clin. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/opo.12288","article-title":"Diurnal variation of anterior scleral and conjunctival thickness","volume":"36","author":"Read","year":"2016","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"5121","DOI":"10.1167\/iovs.11-7364","article-title":"Diurnal variations in axial length, choroidal thickness, intraocular pressure, and ocular biometrics","volume":"52","author":"Chakraborty","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1167\/tvst.7.3.15","article-title":"Macular choroidal thickening in keratoconus patients: Swept-source optical coherence tomography study","volume":"7","author":"Catanese","year":"2018","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/ICO.0b013e31825240d7","article-title":"Central and peripheral corneal thinning in keratoconus","volume":"32","author":"Brautaset","year":"2013","journal-title":"Cornea"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.jcrs.2014.08.035","article-title":"Evaluation of scleral and corneal thickness in keratoconus patients","volume":"41","author":"Schlatter","year":"2015","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1167\/iovs.61.4.6","article-title":"Anterior sclera undergoes thinning with increasing degree of myopia","volume":"61","author":"Dhakal","year":"2020","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s10384-021-00870-4","article-title":"Assessment of the anterior scleral thickness in central serous chorioretinopathy patients by optical coherence tomography","volume":"65","author":"Shi","year":"2021","journal-title":"Jpn. J. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.oret.2020.07.011","article-title":"Scleral thickness in central serous chorioretinopathy","volume":"5","author":"Imanaga","year":"2021","journal-title":"Ophthalmol. Retina"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1167\/iovs.64.1.16","article-title":"Relationship between scleral thickness and choroidal structure in central serous chorioretinopathy","volume":"64","author":"Imanaga","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Alonso-Caneiro, D., Read, S.A., Vincent, S.J., Collins, M.J., and Wojtkowski, M. (2016). Tissue thickness calculation in ocular optical coherence tomography. Biomed. Opt. Express., 7.","DOI":"10.1364\/BOE.7.000629"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1038\/eye.2000.154","article-title":"Does ethnic origin influence the incidence or severity of keratoconus?","volume":"14","author":"Pearson","year":"2000","journal-title":"Eye"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/20\/2280\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:12:44Z","timestamp":1760112764000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/20\/2280"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,14]]},"references-count":36,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["diagnostics14202280"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14202280","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,14]]}}}