A 24-year-old is diagnosed with forme fruste keratoconus (abnormal topography, Kmax 46.5D, no clinical signs). He desires refractive correction. The most appropriate management to both correct refraction and halt progression is:

• A LASIK with standard ablation
• B Phakic intraocular lens (ICL) implantation alone
• C PRK with mitomycin C
• D Corneal collagen cross-linking (CXL) followed by phakic IOL or rigid gas-permeable contact lenses ✓

Explanation

Keratoconus, including forme fruste (subclinical), is a contraindication for ablative refractive surgery (LASIK, SMILE, PRK) as stromal removal weakens an already ectatic cornea and accelerates progression. Management combines corneal cross-linking (CXL with riboflavin and UV-A) to halt progression by stiffening corneal collagen, followed by phakic IOL (e.g., ICL) for spherocylindrical correction if cornea is stable, or rigid contact lenses for irregular astigmatism. PRK even with MMC is not safe in confirmed or forme fruste keratoconus.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.