Diagnostic Significance Of Endothelial Microscopy In The Detection Of Iatrogenic Keratoectasia

The purpose of the study is to identify the possibility of using endothelial microscopy for screening and diagnosis of this complication, which will allow timely detection and prevention of the development of keratoectasia in patients after corneal surgery.

We observed 30 patients (54 eyes) with iatrogenic keratoectasia that developed after refractive surgery. The age of the patients ranged from 22 to 63 years. 

All patients underwent an analysis of the average thickness of the cornea using optical coherence tomography (OCT) and an assessment of the magnitude of astigmatism using an autorefractometer. Patients were also subjected to computer topography of the cornea to assess the central thickness and curvature of the cornea. Endothelial microscopy was carried out using an automated non-contact microscope TOMEY EM 400. The microscope automatically counts the number of endothelial cells per unit area of ​​the cornea. Also, it is able to determine the shape and size of cells.

 In 15 cases, in the epithelial layer there were various types of epitheliopathy, characterized by an increase in the number of hyperreflexive
 cells, their deformation and blurred boundaries, and desquamation of epithelial cells. The amount of endothelium in patients with keratoconus decreased by 
26.3% compared to the control group. The amount of studied endothelium per 1 mm² (CD) decreased by 11.8% compared to the control group. The fluctuating 
zone coefficient of the studied endothelium (CV) was 15.7% higher in patients with keratoconus than in the control group.
The central thickness of the cornea in patients with keratoconus averaged 479.3±12.82 nm², which is 4.5% less than in the control group.

Endothelial microscopy plays an important role in the early detection and monitoring of iatrogenic keratoectasia, which allows timely measures to prevent its progression and the development of serious complications. It is necessary to monitor the density of cells, the thickness of the cornea, its shape and other parameters in order to ensure successful restoration of vision and avoid possible complications.