Keratoconus associated with choroidal neovascularization: a case report

Abstract

Introduction: Keratoconus and choroidal neovascularization can occur as a result of dysfunction of the epithelium and its basement membrane.

Case presentation: A 17-year-old Asian man, who was diagnosed with myopic choroidal neovascularization in both eyes and who subsequently underwent intravitreal injection of ranibizumab (Lucentis(R)) five times over six months, presented with further vision decrease and pain in his right eye. Examination showed corneal steepening and stromal edema in the inferocentral cornea of his right eye, both of which were indicative of advanced keratoconus with acute hydrops. Corneal topography also showed features consistent with keratoconus in his left eye. Fluorescein angiography and optical coherence tomography revealed choroidal neovascularization-associated subretinal hemorrhages and lacquer cracks in both eyes.

Conclusion: Keratoconus and choroidal neovascularization, possibly resulting from dysfunction of the epithelium and its basement membrane, can occur together in the same individual. This would suggest a possible connection in pathogenesis between these two conditions.

Figure 1

Fundus photography (A, B), fluorescein angiography (C, D), optical coherence tomography (E, F) of both eyes. Submacular hemorrhages are shown in both eyes (A, B). Fluorescein angiography revealed blocked fluorescence in the maculae of both eyes due to subretinal hemorrhages (C, D) with focal leakage at the level of retinal pigment epithelium in the right eye (C). Optical coherence tomography revealed multiple interruptions in Bruch's membrane with subretinal elevation in both eyes (E, F).

Figure 2

Fundus photography (A, B) and fluorescein angiography (C, D). Lacquer cracks are prominent in both eyes after subretinal hemorrhages subsided.

Figure 3

Anterior segment photography of the right eye (A) and corneal topography of the left eye (B). Corneal steepening is seen in the inferior paracentral area and stromal edema with the rupture in Bowman's layer (A). Irregular astigmatism is seen with inferosuperior asymmetry and corneal steepening, indicative of keratoconus of the left eye (B).