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BioMed Research International
Volume 2016 (2016), Article ID 5067853, 5 pages
Research Article

An In Vivo Confocal Microscopic Study of Corneal Nerve Morphology in Unilateral Keratoconus

1Narayana Nethralaya Eye Hospital, Bangalore 560010, India
2Academic Hospital, Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands

Received 12 November 2015; Accepted 6 January 2016

Academic Editor: Dipika V. Patel

Copyright © 2016 Natasha Kishore Pahuja et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. To study the corneal nerve morphology and its importance in unilateral keratoconus. Materials and Methods. In this prospective cross-sectional study, 33 eyes of 33 patients with keratoconus in one eye (Group 3) were compared with the other normal eye of the same patients (Group 2) and 30 eyes of healthy patients (Group 1). All patients underwent detailed ophthalmic examination followed by topography with Pentacam HR and in vivo confocal microscopy (IVCM). Five images obtained with IVCM were analyzed using an automated CCmetrics software version 1.0 for changes in subbasal plexus of nerves. Results. Intergroup comparison showed statistically significant reduction in corneal nerve fiber density (CNFD) and length (CNFL) in Group 3 as compared to Group 1 ( and , resp.) and Group 2 ( and , resp.). Though corneal nerve fiber length, diameter, area, width, corneal nerve branch density, and corneal total branch density were found to be higher in decentered cones, only the corneal nerve branch density (CNBD) was found to be statistically significant () as compared to centered cones. Conclusion. Quantitative changes in the corneal nerve morphology can be used as an imaging marker for the early diagnosis of keratoconus before the onset of refractive or topography changes.