Extremely Advanced Bilateral Keratoconus With Central Corneal Thickness Below 100 Microns: A Rare Case Presentation

To report an exceptionally rare presentation of extremely advanced bilateral keratoconus with central corneal thickness below 100 µm and to discuss the associated diagnostic and therapeutic challenges.

Tertiary care ophthalmology center

A single-patient case report of a 32-year-old male who presented with progressive bilateral visual deterioration over two years. Comprehensive ophthalmic evaluation was performed, including best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, corneal tomography (Pentacam), and pachymetry to assess disease severity and guide management planning.

Examination showed advanced bilateral keratoconus with stromal thinning, Vogt’s striae, Fleischer rings, and central scarring. BCVA was 3/60 in the right eye and 2/60 in the left, with no improvement on refraction. Pentacam revealed severe ectasia with Kmax of 102.8 D in the right eye. Pachymetry demonstrated extreme thinning: 98 µm (right) and 180 µm (left). Due to the marked thinning and scarring, corneal cross-linking and intrastromal ring segments were contraindicated. The patient was intolerant to contact lenses, and deep anterior lamellar keratoplasty was planned.

Extremely advanced keratoconus with central corneal thickness below 100 µm is exceedingly rare and presents significant management challenges. Conventional therapeutic options such as corneal cross-linking and intrastromal ring segments may be contraindicated in such cases. Early detection remains critical, as keratoplasty may be the only viable intervention in ultra-thin corneas. Further research is warranted to develop safe and effective treatment strategies for extreme corneal thinning.