TEN YEAR FOLLOW UP OF SEVERE EVOLUTIF UNILATERAL KERATOCONUS TREATED WITH TRIPLE PROCEDURE

Keratoconus is an evolving condition that has benefited from great progress in therapeutic tools. The key element in the success of treatment is to be able to reconcil at the same time: stopping the progression of the disease, improving visual acuity and stabilizing of the refractive result over time in long term.

We report the case of a 26-year-old young man who has been followed at the center since the age of 16 for severe unilateral left keratoconus on a ground of allergic conjunctivitis. The best initial corrected visual acuity at the time of diagnosis was 1/10 . the right eye had a better corrected visual acuity of 10/10 without topographic anomaly.

Tthe patient underwent a triple procedure combining crosslinking, intracorneal rings and phakic implant. The initial management at the time of diagnosis consisted of:

- treatment of conjunctivitis and stopping of rubbing

 – Crosslinking epi Off of the left eye

 - adaptation to LRGP Four years later the patient presented intolerance to lenses, ICR  were  therefore carried out, followed by a correction by glasses, allowing a better visual acuity corrected to 9/10.

 The right eye was always without topographic anomalies under strict clinical and topographic.Five years later, a toric phakic implant correcting the residual spherocylidric ametropia after ICR was implanted .The follow-up was carried out by regular control of the best visual acuity without and with correction, topographic examination of the cornea, oct of SA and aberometry. The result of the long-term follow-up over a period of 10 years shows very s satisfying anatomical  and functional results with a better corrected visual acuity of the left eye of 0.9, a stable K ma  and minimum pachymetry  . 

This clinical case illustrates the possibility of offering the patient with severe keratoconus a satisfying and stable long-term result by combining corneal remodeling and phakic implantation procedures, if the management and follow-up protocol is adapted to the degree disease severity and topographic data.