Cornea Cases

Title:

Role of epithelial mapping and stromal elevation maps in identifying masquerades of keratoconus progression

Case Report Details

First Author: K.Gupta INDIA

Co Author(s):    R. Shetty   P. Khamar   A. Roy              

Abstract Details

Purpose:

To understand the role of epithelial mapping and stromal elevation maps in differentiating true keratoconus progression from pseudo-progression.

Setting:

Narayana Nethralaya

Report of case or case series:

A 25-year-old male presented to us with complains of diminution of vision in both the eyes. His unaided visual acuity was 6/12 in both the eyes (OU). His best-corrected visual acuity (BCVA) with spectacles was 6/6 OU with Plano/-2DC at 65°OD and Plano/-3.25DC at 120° OS. On slit-lamp biomicroscopic examination, presence of Vogt's striae in the left eye were documented. Rest of the anterior segment examination and dilated fundus examination were normal OU. Based on the corneal topography on Pentacam HR, a diagnosis of stage 2 (Amsler Krumeich classification) keratoconus OU was made. As the patient had a BCVA of 6/6 and a low risk of progression according to our previously published nomogram, no surgical intervention was planned. He was prescribed a combination of Trehalose and sodium hyaluronate 1% eye drops OU four times a day for 6 months. At 6 months follow-up, Pentacam-HR comparative maps were suggestive of progression OU. On MS-39, epithelial thickening around the area of the cone noted. There were no changes in the stromal elevation or posterior elevation. Thus, the steepening on pentacam comparative map may be attributed epithelium remodeling around the cone region. The epithelial remodeling is masquerading as progression, hence a diagnosis of pseudoprogression was made and the patient was kept under observation.

Conclusions/Take Home Message:

Epithelial thickness changes mask the irregular stromal surface in keratoconus. The stromal elevation can be mapped compared over subsequent visits using the MS 39. MS-39 comparative epithelial and stromal elevation maps play an important role in thus differentiating differentiating pseudo progression from true progression.