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4 Case Study |
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4.9 |
Case 9 |
4.9.1 Step 1: Analyzing Step |
An 18-year-old male came with very advanced KC in his right eye and less severe KC in his left eye. He used to use contact lenses with different types, but he became no more tolerant. He is a student in the university and he feels as if he was blind as he says.
His MR is (Table 4.9.1):
Table 4.9.1 Manifest refraction |
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|
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||
Eye |
Sphere |
Cylinder |
Axis |
UCVA |
BSVCA |
OD |
Un-recordable |
|
|
CF 3 m |
?? |
OS |
−8 |
−4.5 |
100 |
0.05 |
0.4 |
Slitlamp examination shows clear corneas with stress lines in both eyes. Other ocular examination is within normal limits.
Both eyes will be studied: Figure 4.9.1 is R.E corneal topography and Fig. 4.9.2 is R.E anterior curvature map. Figure 4.9.3 is L.E corneal topography and Fig. 4.9.4 is L.E anterior curvature map.
1. The patient is young; his age is within the progressing age of KC.
2. The case is very advanced in the right eye and to less extent in the left eye.
3.Both corneas are clear but with stress lines.
4.Corneal topography.
(a)The right eye:
•Figure 4.9.1 is corneal topography of the right eye. Corneal thickness at the thinnest location is 289 m, the maximal K-reading is 74.9 dpt, and the Km is 61.9 dpt.
•Figure 4.9.2 is the anterior curvature map. The pattern of the curvature map is relatively strange, it can be considered as the junctional type, and according to the author’s classification, it is pattern 1.
•Looking at the elevation maps in Fig. 4.9.1 reveals that the cone on the anterior map is located inferiorly; at the same time, it represents
Fig. 4.9.1 Corneal topography of the right eye: very advanced KC
4.9 Case 9 |
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Fig. 4.9.2 Anterior curvature map of the right eye. The curvature pattern is AB/IS and can be considered as the junctional pattern. According to author’s classification, it is pattern 1
Fig. 4.9.3 Corneal topography of the left eye: advanced PLK
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4 Case Study |
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Fig. 4.9.4 Anterior curvature map of the left eye. The curvature map is PLK. According to author’s classification, it is pattern 5
a very big posterior out-bulging on the posterior elevation map.
•According to Krumeich, this case can be considered as grade 4.
(b)The left eye:
•Figure 4.9.3 is corneal topography of the left eye. Corneal thickness at the thinnest location is 362 m, the maximal K-reading is 61.4 dpt, and the Km is 52 dpt.
•Figure 4.9.4 is the anterior curvature map. When considering other maps, it is PLK, and according to the author new classification, it is pattern 5.
•According to Krumeich, this case is grade 3.
4.9.2Step 2: Management Suggestion
Table 4.9.2 summarizes patient data and the corresponding individual suggestion(s) for treatment, and presents with a final summary of the best management.
Table 4.9.2 Management suggestions |
|
|
Factors |
Patient data |
Suggested treatment |
Progression |
? |
Observation |
CL tolerance |
Intolerant |
Other modalities |
Age |
18 |
CxL |
Sex |
Male |
|
Transparency and |
Clear but with |
DALK |
stress lines |
stress lines |
|
Refractive error |
R.E: |
DALK |
(S.E) |
Un-recordable |
|
|
L.E: −10.25 |
IORLs or DALK |
BSCVA Vs |
R.E: very poor |
DALK |
UCVA |
L.E: very |
CxL and PRK |
|
good |
or ICRs or IORLs |
K-max |
R.E: 74.9 |
R.E: DALK |
|
L.E: 61.4 |
L.E: ICRs |
|
|
or IORLs |
Corneal thickness |
R.E: 289 m |
R.E: DALK |
at thinnest |
L.E: 362 m |
L.E: ICRs or IORLs |
location |
|
or DALK |
Management |
R.E: DALK |
|
summary: |
L.E: ICRs or IORLs or DALK |
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4.9 Case 9 |
145 |
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Fig. 4.9.5 Corneal topography of the right eye 6 months after DALK
Fig. 4.9.6 Anterior curvature map of the right eye 6 months after DALK. There is with-the-rule astigmatism. The cornea is very regular. If removal of sutures is done under control of topography, the cornea will be regular and homogenous