The Superficial Stromal Scar Formation Mechanism in Keratoconus: A Study Using Laser Scanning In Vivo Confocal Microscopy

Figure 3

In vivo confocal microscopy images of the stroma in sub-Bowman’s (top row) and anterior (middle row) and posterior stroma (bottom row) in the healthy controls, the mild-to-moderate keratoconus group, and the advanced keratoconus group, respectively. Image size:  μm. (A1) Normal keratocytes. Clearly demarcated, highly reflective, oval keratocyte nuclei. (B1) Activated nuclei with variable morphology that are unidentifiable individually. Highly reflective extracellular matrix (ECM). (C1) Lower keratocyte density and higher ECM reflectivity than (A1) and (B1). Hyperreflective keratocytes with activated nuclei and fewer cytoplasmic processes. (A2) Normal keratocytes. Lower keratocyte density than sub-Bowman’s stromal keratocyte density. (B2) Activated keratocytes, thin and varied-orientation bands, and highly reflective ECM. (C2) Wider and regular bands and hyperreflective deposits were visible. (A3) Normal keratocytes in the posterior stroma. (B3) Wider and orthorhombic bands, rare keratocyte nuclei located in the bands. (C3) The number of bands was greater than those in the mild-to-moderate keratoconus group, and the arrangement of striae was more disordered.