Association of Keratoconus with Elevated Serum Low-Density Lipoprotein (LDL): A Cross-Sectional Comparative Study

Abstract

Background: Keratoconus (KC/KCN) is a progressive corneal ectasia traditionally considered a localized biomechanical disorder; however, emerging evidence highlights the role of systemic metabolic factors and oxidative stress in its pathogenesis.
Objective: This study aims to evaluate the association between serum low-density lipoprotein (LDL) levels and progressive keratoconus in a Bangladeshi cohort.
Methods: This case-control study was conducted from July 2024 to June 2025 at Vision Eye Institute and Hospital, Dhaka. It included 47 patients with progressive keratoconus and 48 age- and gender-matched controls with refractive errors but no keratoconus. Progression was defined as >1.00 D(Diopter) increase in K-max (maximum keratometry) over one year with minimum pachymetry ≥400 µm. Exclusion criteria eliminated confounding systemic and ocular conditions. Fasting lipid profile, blood glucose, BMI, keratometry, and pachymetry were assessed. Statistical analysis was performed using SPSS, with p < 0.05 considered significant.
Results: No significant differences were found in age (p = 0.29), gender (p = 0.47), BMI (p = 0.62), or fasting glucose (p = 0.68) between groups. Total cholesterol, triglycerides, and HDL were also comparable. However, mean LDL was significantly higher in keratoconus patients (112.86 ± 36.34 mg/dL) compared to controls (97.78 ± 31.89 mg/dL, p = 0.03). Corneal parameters differed significantly, with higher K-max (57.41 ± 5.17 D vs. 46.19 ± 3.61 D, p < 0.01) and lower pachymetry (481.32 ± 56.33 µm vs. 532.59 ± 42.37 µm, p < 0.01).
Conclusion: Elevated serum LDL is significantly associated with keratoconus, suggesting a potential role of systemic metabolic factors and oxidative stress in its pathogenesis. Monitoring dyslipidemia may aid in risk stratification and management, warranting further research.

The Journal of Ad-din Women's Medical College; Vol. 14(1), Jan 2026; p 25-33