Early Clinical Outcomes Of A Novel Corneal Screening And Treatment Algorithm In Keratoconus Patients

Keratoconus remains a major cause of progressive visual impairment in young and working-age populations, particularly in regions with limited access to advanced corneal diagnostics. Despite the availability of corneal topography and tomography, delayed diagnosis and inconsistent treatment sequencing continue to result in avoidable disease progression and suboptimal outcomes. The purpose of this study was to evaluate early clinical outcomes of a structured corneal screening and treatment algorithm integrating topographic analysis, biomechanical risk stratification, and stage-adapted therapeutic interventions in patients with keratoconus.

This study was conducted at the Department of Cornea and Refractive Surgery, Republican Specialized Scientific-Practical Medical Center of Eye Microsurgery, Tashkent, Uzbekistan — a national tertiary referral center managing a high volume of keratoconus and ectatic corneal disorders.

A prospective observational clinical study was conducted in patients with suspected or confirmed keratoconus. All patients underwent a standardized screening protocol including slit-lamp biomicroscopy, corneal topography/tomography, pachymetry, and structured clinical staging. Based on disease severity and progression risk, patients were allocated to an algorithm-guided management pathway incorporating observation, corneal collagen cross-linking, customized excimer laser procedures, or sequential treatment strategies. Early postoperative and short-term follow-up outcomes were analyzed, focusing on visual acuity, corneal stability indicators, and safety parameters.

Implementation of the screening and treatment algorithm enabled earlier detection of keratoconus, including subclinical and early-stage disease that may be missed by conventional diagnostic approaches. Algorithm-guided decision-making improved consistency in treatment selection and sequencing. Short-term outcomes demonstrated stabilization of key corneal parameters in the majority of treated eyes, with functional visual improvement observed in appropriately selected cases. No sight-threatening complications were recorded during the early follow-up period. Nevertheless, inter-individual variability in biomechanical response and limited follow-up duration preclude definitive conclusions regarding long-term disease progression control.

A structured corneal screening and treatment algorithm appears to be a feasible and clinically valuable approach for the early diagnosis and management of keratoconus in real-world practice. By combining topographic assessment with risk-oriented treatment selection, this strategy may reduce diagnostic delay and improve early outcomes. Nevertheless, limitations include the absence of long-term follow-up, restricted biomechanical parameter integration, and the need for comparative controlled studies. Further large-scale prospective trials incorporating advanced biomechanical metrics are required to validate long-term efficacy and refine algorithm-based keratoconus management.