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Keratoconus in Saudi Arabia: phenotype and therapeutic implications in 999 patients

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Session Details

Session Title: Cornea - Surgical III

Session Date/Time: Sunday 06/09/2015 | 14:15-16:15

Paper Time: 14:15

Venue: Room 16

First Author: : S.Al-Swailem SAUDI ARABIA

Co Author(s): :    A. Al-Bahlal   A. Al-Qassimi                 

Abstract Details


To evaluate the demographic profile, severity at diagnosis and management of Keratoconus (KC) in patients referred to the largest tertiary eye hospital in Saudi Arabia (SA).


King Khaled Eye Specialist Hospital, Saudi Arabia.


Retrospective review of 1952 eyes of 999 KC patients between Jan.2010 and Dec 2010. Exclusion criteria included patients with no corneal topography or best corrected visual acuity (BCVA). Main outcome measures included: age, gender, associated ocular or systemic diseases, family history, central corneal thickness, Amsler-Krumeich classification for staging the disease severity into 4 stages, staging asymmetry between both eyes in bilateral cases, Snellen uncorrected visual acuity (UCVA), Snellen BCVA with spectacle and contact lens (CL), central sub-epithelial and deep stromal scarring (CS), corneal collagen cross-linking (CXL), intrastromal corneal ring segments (ICRS) and penetrating keratoplasty/deep anterior lamellar keratoplasty (PK/DALK).


Mean age at diagnosis and referral were 21.4 and 28.2 years, respectively. Male to female ratio was 2:1. Frequencies of 4 stages in order were: 44.4%, 21.3%, 6.4% and 23.2%. KC in children (less than 15 years, n=162) was significantly more sever at diagnosis, with 30.2% being stage 4 vs. 7.7% of adults (more than 30 years, n=77). Median UCVA and BCVA were 20/125 and 20/25, respectively. Management: spectacles (19.9%), CL (28.6%), CXL (3.9 %%), ICRS (10.6%) and PK/DALK (39.1%). CS was significantly more present (59.2%) in eyes required PK/DALK, and 55.8% of which were of stage 3 and 4.


At diagnosis, half of KC patients were below age of 20 years. young male patients with early KC onset and early need of PK/DALK represented the majority of referred patients, probably reflecting the impact of the disease in their visual function and quality of life. Saudi KC patients are similar to those reported in Indians with regards to early disease-onset, advanced stages, rapid progression, more CS and lower CL tolerance. These may be related to genetic and / or environmental factors. Early detection, close monitoring and more CXL are therefore crucial in young Saudi patients.

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