Phosphatic metabolites in keratoconus.

Sixteen corneal buttons were obtained from 16 patients with keratoconus at the time of penetrating keratoplasty (mean age, 34 +/- 3.2 yr) and prepared for phosphorus-31 nuclear magnetic resonance spectroscopy following perchloric acid extraction. The corneas were compared with age-matched corneas from fresh eye-bank eyes with normal slit-lamp biomicroscopic appearance. Higher levels (P less than 0.05) of nucleoside monophosphates and choline phosphate and lower levels (P less than 0.05) of adenosine diphosphate were detected in keratoconus than in eye-bank corneas. The level of an unidentified metabolite at 3.96 delta, present in eye-bank corneas, was ninefold higher in keratoconus corneas. Another unidentified metabolite at 3.31 delta, accounting for 1.5% of the total detected phosphatic metabolites, appeared in keratoconus but not in eye-bank cornea spectra. These findings of altered phosphatic metabolites are consistent with altered corneal metabolism. The unidentified, unknown metabolites in the spectral profile uniquely distinguish keratoconus from eye-bank corneas.