A patient with keratoconus has apical scarring reducing BCVA to 6/60 with spectacles but achieves 6/9 with a rigid gas-permeable (RGP) contact lens. The MOST appropriate definitive surgical management for this patient is:

• A LASIK refractive surgery
• B Corneal collagen cross-linking (CXL)
• C Intrastromal corneal ring segment (ICRS/Intacs) insertion
• D Penetrating keratoplasty (PKP) ✓

Explanation

Penetrating keratoplasty (PKP) is indicated in keratoconus when: (1) there is contact lens intolerance or failure, (2) apical scarring impairs best-corrected vision, or (3) the cornea is too thin for other procedures. This patient has apical scarring reducing BCVA with spectacles to 6/60 — a clear indication for PKP. CXL is for early-to-moderate progressive keratoconus without significant scarring. ICRS insertion is for RGP-intolerant patients with moderate keratoconus without scarring. LASIK is absolutely contraindicated in keratoconus as it further weakens the ectatic cornea.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.