A 28-year-old nurse is found to have forme fruste keratoconus — asymmetric topography with subtle inferior steepening, normal pachymetry (540 μm), and best-corrected VA of 6/6. She requests LASIK. What is the most appropriate counselling?

• A LASIK is safe; her cornea is thick enough for the procedure
• B LASIK is absolutely contraindicated; offer spectacles or rigid contact lenses only
• C LASIK is contraindicated; consider corneal cross-linking followed by phakic IOL if needed ✓
• D LASIK is contraindicated; PRK is the preferred alternative since it avoids flap creation

Explanation

Forme fruste keratoconus is a contraindication for LASIK and PRK because both ablate stromal tissue and can accelerate ectasia. The current preferred management is corneal collagen cross-linking (CXL) to halt progression, followed by assessment for phakic IOL or other correction methods. PRK on a keratoconic cornea also risks ectasia progression, though less severe than LASIK; it is not the preferred approach when ectasia risk exists.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.