A Case of True Superior Keratoconus Confirmed Using Multiple Imaging Modalities

JOURNAL TITLE: International Journal of Keratoconus and Ectatic Corneal Diseases

Author
1. Onur Özalp
2. Nilgün Yıldırım
3. Eray Atalay
ISSN
2277-3800
DOI
10.5005/jp-journals-10025-1180
Volume
8
Issue
2
Publishing Year
2019
Pages
3
Author Affiliations
    1. Department of Ophthalmology, Eskisehir Osmangazi University Medical School, Eskişehir, Turkey
    1. Department of Ophthalmology, Eskisehir Osmangazi University Medical School, Eskişehir, Turkey
    1. Department of Ophthalmology, Eskisehir Osmangazi University Medical School, Eskişehir, Turkey
  • Article keywords
    Anterior segment optical coherence tomography, Epithelial thickness, Superior keratoconus, Tomography, Topography

    Abstract

    Aim: To report an unusual case of a newly diagnosed bilateral superior keratoconus in an elderly patient. Background: We report a case of bilateral superior keratoconus in a 64-year-old woman who was diagnosed after having presented with hydrops in one eye. Case description: Uncorrected visual acuity was counting fingers from 3 and 1 meter for the right and left eyes, respectively. A superiorly located deep stromal scar and chronic corneal edema consistent with a diagnosis of corneal hydrops were noted for the left eye. Although the cornea was clear, there was superior corneal protrusion in the right eye. Pentacam and Orbscan demonstrated overlapping focal corneal thinning, increased back elevation, and steepening in the superior cornea. Anterior segment optical coherence tomography (AS-OCT) showed stromal and epithelial thinning in the superior cornea and significant compensatory epithelial thickening in the opposing quadrant. In light of these findings, a diagnosis of superior keratoconus was established. Conclusion: Superior keratoconus is a rare condition. Meticulous evaluation of corneal tomography and epithelial thickness profile is crucial for localizing the superior cone in keratoconus. Clinical significance: This is the first case report demonstrating epithelial thickness profile in a superior keratoconus case.

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