Corneal endothelial morphology in vitiligo: a cross-sectional study with subgroup analysis of periocular involvement

PURPOSE: To evaluate corneal endothelial morphology and anterior segment parameters in patients with vitiligo and to investigate the potential impact of periocular involvement on endothelial characteristics. METHODS: In this cross-sectional observational study, 50 patients with vitiligo and 50 age- and sex-matched healthy controls were enrolled. Vitiligo patients were subdivided according to the presence or absence of periocular involvement. All participants underwent comprehensive ophthalmologic examination including autokeratorefractometry, Goldmann applanation tonometry, slit-lamp biomicroscopy, axial length measurement, and specular microscopy. Corneal endothelial parameters including endothelial cell density (CD), hexagonality (HEX), coefficient of variation (CV), and total cell count (N) were analyzed. Statistical comparisons were performed using appropriate parametric and non-parametric tests. RESULTS: Age and sex distribution were comparable between groups (p>0.05). No significant differences were observed between vitiligo and control groups in spherical equivalent, axial length, central corneal thickness, or endothelial parameters (CD, HEX, CV, N) (p>0.05 for all). Subgroup analysis revealed significantly higher endothelial cell density in the periocular vitiligo group compared with the non-periocular subgroup (p=0.008), while other endothelial indices remained similar. CONCLUSION: Corneal endothelial morphology appears preserved in patients with vitiligo. The disease does not seem to confer clinically significant reduction in endothelial reserve or increased surgical risk related to endothelial compromise. Periocular involvement may represent a biologically distinct subset; however, no evidence of endothelial vulnerability was observed. Longitudinal studies incorporating multimodal imaging are warranted.