: Keratoconus is a Greek term where keras means

: Keratoconus is a Greek term where keras means cornea and konos  means cone and was first described in the
literature in 1854(Nottingham). Its etiology is affected by genetic as well as
environmental factors 1. Keratoconus is an ectatic degeneration which is
progressive and is characterized by thinning of central and paracentral cornea.
It is presented clinically with various signs and symptoms which show up at
different stages as increase in corneal curvature, irregular astigmatism, loss
of best corrected visual acuity, Fleischer’s ring, Munsen’s sign and Vogt’s
sign. The etiopathogenesis of the disease is not so well understood and various
theories of various researchers have been put forward in due course of time to
explain the stromal weakness and ectasia which include heredity, abnormality of
corneal collagen, the role of keratocytes, corneal innervation and inflammation
2,3. It usually occurs in the late teens or the early 20’s and is progressive
where it stabilizes in the late 40’s and is prevalent in both the genders 1. Keratoconus
has had ben classified on the basis of its keratometric readings, distorted
mires and the size of the cone. But now due to the introduction of newer
techniques to evaluate the corneal condition, the keratoconus stages may be
classified according to the central corneal steepening and topographical and
morphological patterns of the cornea using various topographic maps. It has
been classified based on the cone location (central or paracentral), cone
decenration (distance between center of cornea and apex of the cone),
topographical patterns (mild: /=52.00D) and morphological characteristics 3. Since the early
stages of keratoconus are asymptomatic, it is usually detected by the clinician
based on the irregular astigmatism, corneal thinning and increased steepening
of the corneal curvature. The most sensitive tests to rule out the condition
are based on the principles of placido disc and Scheimfplug imaging. The topography
is being considered to be the gold standard. The treatment for the condition
varies with the severity and the vision affected. In the primary stages the
spectacles are prescribed if the vision is improving with, the next step was
using hard contact lenses especially the rigid gas permeable ones. The next
step was the surgical intervention in which the traditional intervention is
penetrating keratoplasty where the full thickness cornea is excised and replaced
by donor cornea yielding better results than lamellar keratoplasty. But now
newer techniques have been introduced like corneal cross linking, deep anterior
lamellar keratoplasty, intact etc. In case of intacts, the two tiny crescent
shaped transparent plastic polymersare surgically placed under the cornea which pushes
the cornea peripherally thereby flattening the surface 6. It had been used
for the patient in his right eye probably to prevent the further steepening
that could have even worsened the vision otherwise. The right eye since already
fit with the intacts was left for observation in the next upcoming visits and
have a close watch upon, but the left eye condition was also worsening each passing
day. So looking at visual perspective of the patient, he needed better vision
and after doing all the topography and corneal thickness checks, the cornea was
found to be suitable enough to undergo the corneal collagen cross linking procedure.
And it was suggested to be done soon to prevent the further steepening of the
cornea. Since it was an extreme case with very steep cornea and the visual
status was also turning worse spectacles would not have served much of the
purpose and would not have helped at all in controlling the condition. The contact
lens was another option but the very steep corneal surface would have been
another challenge questionable if contact lens could alone control the progression.
The patient was also asked for the close follow-ups for following the condition
more closely and handling it in the safest was possible. The topography report
as by pentacam is not just enough to completely read the corneal and the
keratoconus status. The aberrometry along-with the specular microscopy and pachymetry
are equally important to finally come into a conclusion.