Posterior Keratoconus: Theory, Evidence, And Treatment
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR315 | Type: Free paper | DOI: 10.82333/vnt1-yg39
Authors: Dr Fatima R. Alsharif 1 , Dr Qusai F. Abu Salim 2 , Dr Khalid Alsabah 3 , Dr Nour Elghoul 1 , Dr Hashem Abu Serhan* 4
1College of Medicine,Qatar University,Doha,Qatar, 2Department of Ophthalmology,Eye Specialty Hospital,Amman,Jordan, 3College of Medicine,Jordan University of Science and Technology,Irbid,Jordan, 4Department of Ophthalmology,Hamad Medical Corporation,Doha,Qatar
Purpose
This systematic review consolidates current knowledge on the epidemiology, proposed mechanisms, clinical presentation, diagnostic modalities, systemic associations, management strategies, and outcomes of posterior keratoconus (PKC).
Setting
A systematic review.
Methods
Our protocol was registered prospectively on PROSPERO (CRD420251102313). A systematic search of CENTRAL, Web of Science, Embase, PubMed, Scopus, ClinicalTrials.gov, and Google Scholar (1950–present) was conducted following PRISMA guidelines. Eligible studies included case reports, case series, and observational studies reporting clinical, imaging or outcome data. Screening, data extraction, and Joanna Briggs Institute (JBI) quality assessment were performed independently. Narrative synthesis was used due to heterogeneity.
Results
36 studies involving 82 patients were included. PKC was mainly congenital, unilateral, and non-progressive. Developmental arrest or aberrant neural-crest mesenchymal differentiation was the leading proposed mechanism. The most frequent findings were posterior corneal depression, paracentral stromal opacity, and reduced visual acuity from irregular astigmatism or amblyopia. Modern imaging, especially anterior segment optical coherence tomography (AS-OCT) and Scheimpflug tomography, enabled reliable characterisation of posterior excavation. Systemic associations were uncommon. Management was mostly conservative; surgical intervention improved vision when opacities were visually significant, with no reported recurrence.
Conclusions
PKC is a distinct, stable corneal anomaly primarily affecting the posterior surface. Visual impairment is typically refractive or amblyogenic rather than ectatic. More robust prospective data and a global PKC registry are needed.