Could Bilateral Progressive Corneal Ectasia Be Transient? Exploring A Case Of Full Reversibility

Published 2024 - 42nd Congress of the ESCRS

Reference: CC01.08 | Type: Case Report | DOI: 10.82333/zg0k-bc94

Authors: Chiara Bonzano* ¹ , Davide Borroni ² , Federica Tessitore ³ , Carlo Enrico Traverso ¹

¹Eye Clinic, University of Genoa and IRCCS San Martino Polyclinic Hospital,Genova,Italy, ²Riga Stradins University,Riga,Latvia, ³Eye Clinic, University of Genoa and IRCCS San Martino Polyclinic Hospital,genova,Italy

Purpose

To report an unusual case of a fully reversible bilateral progressive corneal ectasia

Setting

Eye Clinic, University of Genoa and IRCCS San Martino Polyclinic Hospital, Genoa, Italy

Report of case

A 24-year-old girl was referred to our clinic due to decreased vision and the recent onset of astigmatism in both eyes (OO). The patient reported a history of Bell's palsy and a recent treatment with isotretinoin. She complained about photophobia, foreign body sensation, and itching, causing frequent eye rubbing. Her distance best-corrected visual acuity(VA) was 20/20 and 20/25 in the right and left eye. Corneal topography showed irregular astigmatism and an abnormal Surface Asymmetry Index (SAI) in OO. The elevation and complex aberration indices were compatible with KC. The instrument statistical analysis software classified the map as 40% KC similarity and 60% KC severity in the best eye. The pachymetry map detected KC's eccentric corneal thinning characteristics in OO. Slit-lamp examination revealed conjunctival injection and upper tarsal giant papillae in OO. The patient was instructed to avoid eye rubbing. Preservative-free tear substitute and 0.1% cyclosporine ophthalmic emulsion quid were prescribed. At 3, 6, 9, and 12- month follow-ups, slit-lamp findings revealed a regression of hyperemia and giant papillae and improved tear stability with an uncorrected VA of 20/20 in OO. The topography showed a regression of the corneal ectasia in OO. The KC screening application did not detect any anomalies.

Conclusion/Take home message

Unrecognized Vernal keratoconjunctivitis (VKC) can lead to anatomical and refractive consequences. The prevalence rate of KC is 26.8% among VKC patients, whereas abnormal topography may appear in up to 71% of them. In our case, the association between corneal ectasia and VKC may reflect the eye-rubbing-related corneal response. Treatment with 0.1% cyclosporine led to a favorable evolution in clinical and anatomical indices, proving to be a good treatment. Proper recognition of the VKC complications is crucial, as most of these can be managed or prevented. Despite the accuracy of diagnostic tools in diagnosing KC, they cannot replace an accurate clinical examination.