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Purpose <p>To evaluate peripheral-central epithelial thickness (ET) gradients in eyes with keratoconus and regular astigmatism, and to determine their potential utility as a non-invasive biomarker for disease detection in early-stage keratoconus.</p> Methods <p>This retrospective cross-sectional analyzed ET with spectral-domain OCT at the cone apex and at 3&#xa0;mm in the superior, temporal, nasal, and inferior directions. Epithelial thickness gradients (ΔET) were calculated as the difference between peripheral and central ET. Statistical comparisons were performed using non-parametric tests, with significance set at <i>p</i> &lt; 0.05.</p> Results <p>A total of 396 eyes (208 keratoconus, 188 regular astigmatism) were analyzed. Central ET was significantly reduced in KC (38.55 ± 5.42&#xa0;µm) vs controls (48.78 ± 3.94&#xa0;µm; <i>p</i> &lt; 0.001). While peripheral thickness showed minor differences, the ET gradients (ΔET) were markedly steeper in KC across all quadrants (temporal, superior, nasal, inferior, <i>p</i> &lt; 0.001). Within Stage I KC, eyes with more advanced disease exhibited steeper ΔET values, particularly in the nasal and temporal directions. Mean ΔET, demonstrated significant differences between KC (8.43 ± 4.97&#xa0;µm) and controls (− 1.55 ± 1.77&#xa0;µm;<i> p</i> &lt; 0.001), and correlated positively with steep keratometry (r = 0.521, <i>p</i> &lt; 0.001) and negatively with thinnest corneal thickness (TCT) (r =  − 0.641, <i>p</i> &lt; 0.001).</p> Conclusion <p>ΔET is markedly steeper in keratoconus than in regular astigmatism—even in Stage I—and correlates with steep keratometry and TCT. With areas under the curves (AUCs) up to 0.976, ΔET provides a rapid, non-invasive epithelial-based biomarker for early detection and staging of keratoconus. Its utility for monitoring progression remains to be established in prospective longitudinal studies.</p>

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Epithelial thickness gradients as a diagnostic biomarker for early-stage keratoconus

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Zane Jansone-Langina,
  • Jana Gertnere,
  • Viktorija Kezika,
  • Carlos Rocha-de-Lossada,
  • José-María Sánchez-González

摘要

Purpose

To evaluate peripheral-central epithelial thickness (ET) gradients in eyes with keratoconus and regular astigmatism, and to determine their potential utility as a non-invasive biomarker for disease detection in early-stage keratoconus.

Methods

This retrospective cross-sectional analyzed ET with spectral-domain OCT at the cone apex and at 3 mm in the superior, temporal, nasal, and inferior directions. Epithelial thickness gradients (ΔET) were calculated as the difference between peripheral and central ET. Statistical comparisons were performed using non-parametric tests, with significance set at p < 0.05.

Results

A total of 396 eyes (208 keratoconus, 188 regular astigmatism) were analyzed. Central ET was significantly reduced in KC (38.55 ± 5.42 µm) vs controls (48.78 ± 3.94 µm; p < 0.001). While peripheral thickness showed minor differences, the ET gradients (ΔET) were markedly steeper in KC across all quadrants (temporal, superior, nasal, inferior, p < 0.001). Within Stage I KC, eyes with more advanced disease exhibited steeper ΔET values, particularly in the nasal and temporal directions. Mean ΔET, demonstrated significant differences between KC (8.43 ± 4.97 µm) and controls (− 1.55 ± 1.77 µm; p < 0.001), and correlated positively with steep keratometry (r = 0.521, p < 0.001) and negatively with thinnest corneal thickness (TCT) (r =  − 0.641, p < 0.001).

Conclusion

ΔET is markedly steeper in keratoconus than in regular astigmatism—even in Stage I—and correlates with steep keratometry and TCT. With areas under the curves (AUCs) up to 0.976, ΔET provides a rapid, non-invasive epithelial-based biomarker for early detection and staging of keratoconus. Its utility for monitoring progression remains to be established in prospective longitudinal studies.