Unusual Keratoconus case

By Dr. Amr Mounir

Lecturer of ophthalmologySohag University

A 27 years old woman complaining of unstable refraction with high cylinder with repeated change of glasses.

Refraction:

Rt. Eye : UCVA : 0.1 ----> BCVA: 0.2Lt. eye : UCVA : 0.1 ---> BCVA: 0.2

Pentacam was done

Aberrometry map

Pentacam was done

Aberrometry map

Diagnosis

RT. Keratoconus (grade 3)Lt. Keratoconus ( grade 2)

The first question was……

The Question was……

Despite of this advanced degree of Keratoconus the refraction was

of a low degree !!

The Answer was A scan

The second question was…

Despite of the refraction was low , the patient was

complaining .Why????

Answer:

Problem

What to do for this patient??? Glasses and CXL

OR

Rings and CXL

Glasses and CXL

With :1- Low refraction.2- Increased corneal curvature correct the natural hyperopia

Rings and CXL

With :1- High Keratometry.2- Advanced grade.3- High degree of High order aberration( HOAs).

The decision

Rings and CXL was done for the patient in Rt. eye only to can

judge the result.

Judgment of our results

BY

1- Refraction 2- Pentacam 3- Aberrometry map

Refraction

Rt. Eye : UCVA : 0.2 ----> BCVA: 0.4

Pentacam

Aberrometry map

patient satisfaction

Out come?

1- Improvement in best corrected visual acuity.2- Decreased aberrations.

Increased

Conclusion:

1- Refraction shouldn't be the only

guiding factor in our decision.

2- Change in aberrometry map should be

taken into consideration.

3- Rings are important option in

management of advanced keratoconus.

Thank you