Case report on keratoconus management

Case report on keratoconus management

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  Case report on Keratoconusmanagement MEENAKSHI MOPTOM PR 003
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  Introduction • Keratoconus isa benign, usually bilateral, non- inflammatory, progressive thinning, weakening and ectasia (protrusion) of the cornea, resulting in corneal surface distortion. This leads to visual loss primarily due to a high degree of irregular myopic astigmatism and corneal scarring. • The protrusion usually develops in the infero- central zone of the cornea that results in a cone-like anterior protrusion. While the early stages of the disease usually involve irregular corneal astigmatism with inferior corneal steepening, later stages may involve a cornea that is relatively flat centrally but very steep inferiorly. This can result in hyperopic rather than myopic astigmatism.
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  • Although KCusually occurs bilaterally, the onset of the disease may occur at different times in each eye. • Due to the advent of videokeratoscopes, the detection of keratoconus in its nascent form has increased dramatically thereby increasing the apparent incidence of the condition. • This early form of undeveloped disease with inferior corneal steepening as its hallmark, is also called as forme- fruste KC. • Although the etiology of KC is not fully understood, it is probably multifactorial. • While heredity is believed to be a factor , associations with collagen abnormalities & other atopic diseases have been suggested as additional possible factors . • The evidence implicates an abnormality of stromal collagen tissue.
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  Case Discussion • A24-year-old male was referred for CL Trial • He had history of right eye keratoconus diagnosed 5 years ago. • C3R was done in RE eye 5 years ago. • Rest other history was not contributory. • H/0 using RGP lens on and off in RE and soft toric in LE • Was not aware of the brand name and had last pair of lens with him , for RE he was not comfortable with RGP so was referred for Rose K trial.
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  Investigations • Current glassprescription • OD -4.75 • OS -4.00DS/-0.75DC X 65 • Subjective Refraction • OD -2.75DS/-2.25DC X 90 6/12,N6 • OS -4.00DS/-0.75DC X 90 6/6,N6 • Keratometry • OD K1 6.90mmavg k 6.8 mm K2 6.70mm • OS K1 7.35mm avg k 7.30 mm K2 7.25mm
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  • UCVA 6/18in the right eye and 6/60 in the left eye for distance. • VA with present glasses 6/12 RE and 6/9 LE & • PH visual acuity 6/9 RE and 6/6 LE. • Pupillary examination revealed round pupils which reacted well to light, and RAPD was absent. • Slit Lamp Examination revealed normal lids and conjunctiva, inferior thinning right eye, RRR pupil in both eyes and normal clear lens in the both eyes. • Fundus examination was found within normal limits and optic disc CDR 0.3:1 in both eyes.
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  OD TOPORAPHY
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  OS TOPOGRAPHY
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  CL Trial • OD6.50mm/-8.00DS/8.50mm/STD/ROSE K2 NC • OS 8.6mm/-3.75DS/-0.75DC X 90 /14.20mm/Purevision 2 toric
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  Lens fit assessment RoseK2 NC • Centration – Well centered • Movement with blink = 1.5mm • Movement type= smooth • Speed of movement= average • Stability= yes • With lenses on • VA 6/6p ,n6 • Over refraction plano
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  Lens fit assessment softtoric • Centration- Good in all gazes • Movement with blink primary gaze= 0.3mm • Movement with blink upgaze gaze= 0.5mm • Upgaze lag = 1mm • Horizonatal lag = 1mm • Push up test = 50% • Fit classification= optimal • Patient comfort = 5 • Vision with blank and after blink = 6/6,n6
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  • Final Lensorder • OD 6.50mm/-8.00DS/8.50mm/STD/ROSE K2 NC / FL 90/ GREY • OS 8.6mm/-3.75DS/-0.75DC X 90 /14.20mm/Purevision 2 toric • Both eye lenses were ordered and patient was asked to come for lens collection.
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  Conclusion • In theearly stages, patients with keratoconus can usually achieve adequate visual correction with spectacles. The primary treatment mode initially was the usage of rigid contact lenses and spectacles, while for advance cases keratoplasty was the preferred choice of treatment. However, after the advanced development in the past decade, there have been various therapeutic options now available that have revolutionized the treatment approach for this disease.
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  • There hasbeen a paradigm shift from the preferred Keratoconus treatment option from fitting of contact lens, followed by Deep Anterior Lamellar Keratoplasty (DALK) or Penetrating Keratoplasty (PK) to Ultraviolet-A (UV-A induced collagen cross-linking (CXL) for stabilizing the corneal ectasia for long term. • The recent advances in Keratoconus treatment has introduced the usage of excimer laser application, Phakic IOLs, Intrastromal Corneal Ring Segments (ICRS), as well as the utilization of combination techniques which have resulted in a major contribution to offer effective management options for Keratoconus at different stages of its progression . • The newest technique is the Bowman layer (BL) transplantation which has been introduced recently as a substitute to PK/ DALK for Keratoconus at advance stage, unsuitable for ICRS or UV-CXL.