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Shoichi Sawaguchi, MD; Takeo Fukuchi, MD; Haruki Abe, MD; Tadayoshi Kaiya, MD; Joel Sugar, MD; Beatrice Y. J. T. Yue, PhD

Arch Ophthalmol. 1998;116:62-68.

Objective  To examine the 3-dimensional collagen fibril organization in the Bowman layer of keratoconus corneas.

Methods  Eight keratoconus corneas, 8 corneas with other diseases, and 5 normal human corneas were studied. A cell maceration method in combination with scanning electron microscopy was used to examine the collagen network in the Bowman layer.

Results  In normal corneas, the surface of the Bowman layer was smooth and collagen fibrils were regularly arranged. By contrast, sharply edged defects in the Bowman layer were found in keratoconus corneas. Lattice-like configurations of the ruptured Bowman layer and collagenous scar tissue were observed, to varying degrees, in all keratoconus corneas examined. None of the other diseased corneas exhibited the ruptures.

Conclusions  Scanning electron microscopy demonstrated alterations in the Bowman layer specific to keratoconus. Fragmentation of the Bowman layer may be an early change leading to keratoconus conditions.

From the Departments of Ophthalmology, Niigata University School of Medicine, Niigata (Drs Sawaguchi, Fukuchi, and Abe), and Seirei Hamamatsu General Hospital, Shizuoka (Dr Kaiya), Japan; and Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine (Drs Sugar and Yue).

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