A new perspective on the pathobiology of keratoconus: interplay of stromal wound healing and reactive species‐associated processes

Abstract

Severe loss of vision manifests from the corneal protrusion, thinning and distortion that characterises keratoconus, which in its most severe form is still treated primarily by lamellar or penetrating keratoplasty. Unfortunately, alternative therapeutic options targeting the underlying pathobiology remain limited, attributable to an incomplete understanding of the biological mechanisms instigating stromal deterioration and other disease processes. We postulate that underlying abnormalities in stromal repair and reactive species‐linked activities and the interaction between these phenomena are implicated in the development of keratoconus. This revised interpretation of the pathophysiology may, with further investigation, advance our knowledge and the clinical management of this prevalent ectatic disorder.

Key words:

• cellular biology
• cornea
• disease mechanisms
• keratoconus
• molecular biology
• reactive species
• wound healing

Acknowledgements

The authors wish to thank the Maurice and Phyllis Paykel Trust, the New Zealand National Eye Bank and tissue donors and their families for supporting this project.