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C. J. Danzig, M. P. Ehrenhaus, H. Liu, D. P. Lazzaro, A. V. Kumar; A Case of a 9-Year Male With Bilateral Concomitant Keratoconus and Posterior Lenticonus. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4319.
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To report the case of a pediatric patient with bilateral concomitant keratoconus and posterior lenticonus
A 9-year-old male from Trinidad presented to the SUNY Downstate Eye Clinic with a several year history of progressively worsening vision in his left eye (OS) more than his right eye (OD) and chronic allergic conjunctivitis. He is otherwise healthy with no medical problems and takes no systemic or ocular medications. He has no family history of blindness or eye disease. On examination, he has no stereovision. He is orthophoric at distance and near. His best corrected vision with spectacles is 20/50 OD and 20/150 OS with a refractive error of -4.50 + 2.50 x 105 OD and -6.25 + 3.00 x 180 OS. Slit lamp examination demonstrated a conical-shaped anterior cornea in both eyes (OU) with superficial punctate keratitis inferiorly OU as well as a bilateral oil droplet appearance to the posterior lens, more evident in his left eye. Retinoscopy revealed a distorted light reflex OU. His posterior segment examination was within normal limits. Keratometry readings were 47.60/50.10 OD and 60.5/64.2 OS with distorted mires. Corneal topography was consistent with keratoconus OU. On dilated near pinhole examination, his vision improved to 20/20 OD and 20/30 OS. Rigid gas permeable (RGP) contact lenses improved his vision to 20/25+ OD and 20/25 OS. His manifest over-refraction of -0.75 OD and -1.25 + 1.25 x 165 OS brought his visual acuity to 20/20 OU.
Currently, there have been no cases reported of bilateral, concomitant keratoconus and posterior lenticonus in the English language journals. In the one case reported of unilateral concomitant keratoconus and posterior lenticonus, it did not involve a pediatric patient. Keratoconus is not commonly associated with posterior lenticonus. Traditional treatment in patients with posterior lenticonus is lensectomy with intraocular lens implantation. Our patient’s vision improved to 20/25 OU with RGP contact lenses, thus delaying any surgical intervention.
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