title: Imaging Microscopic Features of Keratoconic Corneal Morphology.
abstract: OBJECTIVE
  To search for gold-standard histology indicators using alternative imaging modalities in keratoconic corneas.
  
  
  METHODS
  Prospective observational case-control study. Fourteen keratoconic corneas and 20 normal corneas (10 in vivo healthy subjects and 10 ex vivo donor corneas) were examined. Images of corneas were taken by spectral domain optical coherence tomography (SD-OCT) and in vivo confocal microscopy (IVCM) before keratoplasty. The same removed corneal buttons were imaged after keratoplasty with full-field optical coherence microscopy (FFOCM) and then fixed and sent for histology. Controls consisted of normal subjects imaged in vivo with IVCM and donor corneas imaged ex vivo with FFOCM. Corneal structural changes related to pathology were noted with each imaging modality. Cell density was quantified by manual cell counting.
  
  
  RESULTS
  Keratoconus indicators (ie, epithelial thinning/thickening, cell shape changes, ferritin deposits, basement membrane anomalies, Bowman layer thinning, ruptures, interruptions, scarring, stromal modifications, and appearance of Vogt striae) were generally visible with all modalities. Additional features could be seen with FFOCM in comparison with gold-standard histology, particularly in the Bowman layer region, whereas the combination of SD-OCT plus IVCM detected 76% of those features detected in histology. Three-dimensional FFOCM imaging aided interpretation of two-dimensional IVCM and SD-OCT data. Basal epithelial cell and keratocyte densities were significantly lower in patients with keratoconus than those in normals (P < 0.0001).
  
  
  CONCLUSIONS
  Structural and cellular assessment of the keratoconic cornea by means of either in vivo SD-OCT combined with IVCM or ex vivo FFOCM in both cross-sectional and en face views can detect as many keratoconus indicators as gold-standard histology.
authors: *Quinze-Vingts National Ophthalmology Hospital, Paris, France; and†Vision Institute/CIC, UPMC Université Paris, UMR_S/INSERM/CHNO des/CNRS, UMR, Paris, France.
authors: Kate
authors: K
authors: Grieve
authors: Cristina
authors: C
authors: Georgeon
authors: Felipe
authors: F
authors: Andreiuolo
authors: Marie
authors: M
authors: Borderie
authors: Djida
authors: D
authors: Ghoubay
authors: Josette
authors: J
authors: Rault
authors: Vincent M
authors: VM
authors: Borderie
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002452:Cell Count; D003315:Cornea / Q000473:pathology*; D003319:Corneal Stroma / Q000473:pathology; D003430:Cross-Sectional Studies; D019573:Epithelium, Corneal / Q000473:pathology; D064368:Healthy Volunteers; D006801:Humans; D007640:Keratoconus / Q000000981:diagnostic imaging*; D018613:Microscopy, Confocal; D064847:Multimodal Imaging; D011446:Prospective Studies; D041623:Tomography, Optical Coherence