A 32-year-old with Amsler grid distortion, progressive myopia (spectacle power changed by −2 D over 3 years), and corneal topography showing inferior steepening with I-S asymmetry >1.4 D is diagnosed with keratoconus stage II (Amsler-Krumeich). He is contact lens intolerant. The MOST appropriate management to halt progression AND improve visual acuity is:
- A Intrastromal corneal ring segments (ICRS) alone
- B Deep anterior lamellar keratoplasty (DALK)
- C Penetrating keratoplasty (PKP)
- D Corneal collagen cross-linking (CXL) followed by topography-guided PRK after stabilization ✓
Explanation
For progressive keratoconus with documented progression (spectacle power change), CXL is the standard of care to halt progression by creating biomechanical stiffening via riboflavin/UV-A-induced collagen cross-link formation. Once progression is halted (typically after 1 year of stability), topography-guided PRK (or ICRS placement) can be performed to improve BCVA — this combination (CXL + topography-PRK) is the Athens Protocol. ICRS alone addresses irregularity but does not halt progression. DALK and PKP are reserved for advanced keratoconus unmanageable by other means, as they carry greater risk and longer recovery.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.