Severe Keratoconus: Watch Out for Complications!

Keratoconus is an evolving condition. The speed and severity of the course differs from patient to patient. We report the clinical observation of a 36-year-old patient with a history of severe atopy and who presents a neglected bilateral keratoconus. The clinical examination found sign of Munson Rizzuti, the corneal protrusion being more marked in the left eye. Biomicroscopic examination revealed corneal opacity in the central right eye with marked corneal protrusion and thinning. In the right eye, there was stromal corneal opacity with neovascularization, superficial and deep scar lines, epithelial microcystic edema and an intrastromal cyst. This finding correspond to anterior segment OCT Sandali stage 4 in both eyes. Penetrating keratoplasty was proposed to the patient for treatment. Subconjunctival injections of 2.5 mg bevacizumab were also undertaken at 1 month intervals. The advent of modern imaging techniques has enabled early diagnosis of keratoconus as well as its monitoring and screening for complications. New classifications aim to stage the pathology and to better codify the management. The most serious complication is the occurrence of corneal hydrops. Adequate management of the latter avoids complications including fibrosis and neovascularization, which improves the prognosis of a subsequent keratoplasty which remains the last resort in these patients.