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Case Reports
. 2025 Feb 4;25(1):59.
doi: 10.1186/s12886-025-03877-4.

Keratoconus with two consecutive re-emergences: a case report

Peicheng Zhang  1 , Yanchao Wu  2 , Lixiao Ma  2 , Dong Wang  2
Affiliations
Case Reports

Keratoconus with two consecutive re-emergences: a case report

Peicheng Zhang et al. BMC Ophthalmol. .

Abstract

Background: Keratoconus is a common disease in clinical practice, and deep anterior lamellar keratoplasty(DALK) is a conventional treatment for keratoconus, which is effective and not easy to recur after surgery.

Case presentation: The author presents a rare case report involving a 21-year-old patient with Consecutive re-emergences of Keratoconus. He underwent DALK for keratoconus in his left eye in 2012 and experienced re-emergence 3 years later, followed by a second deep lamellar keratoplasty in the same year. In 2019, the patient experienced re-emergence of keratoconus and underwent a third deep lamellar keratoplasty in the same eye. Genetic testing was performed, and no abnormal genes were identified. Postoperative follow-up emphasized the management of chronic allergic conjunctivitis (CAC) and the correction of eye-rubbing habits. To date, he has not experienced any further re-emergence.

Conclusions: Keratoconus is a complex disorder with a multifaceted etiology and pathogenesis, including genetic, environmental, biomechanical, and cellular factors. Its treatment usually requires multiple considerations, including the choice of surgical methods, anti-inflammatory therapy, and correction of eye rubbing habits to guide patients for subsequent treatment interventions.

Keywords: Chronic allergic conjunctivitis; Deep anterior lamellar keratoplasty; Eye-rubbing; Keratoconus; Recurrent keratoconus.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient for publication of identifying information/images in an online open-access publication. If necessary, we can provide a copy of the signed consent form. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A The central area of the corneal graft was conical and slightly thinned, with the apex located slightly temporal to the center. B Severe anterior protrusion and stromal scarring, resulting in an inability to obtain images. C The central cornea was thinned and anteriorly protruded, with stromal opacity located in the superficial stroma. D The distribution of anterior stromal cells was uneven, with some activated cells exhibiting nuclear fusion and connection. The dark areas may represent sites of stromal lamellar disruption. E Best-corrected visual acuity after the second DALK is 20/33 (+ 2.00DC × 75)
Fig. 2
Fig. 2
A A horizontal grey-white stromal scar measuring approximately 0.5 × 2.5 mm was seen at the top of the cone, along with a Fleischer ring measuring approximately 4 × 5 mm. B Moderate congestion was observed in the palpebral conjunctiva of the upper eyelid, with numerous papillary projections present. C The cornea exhibited high irregular astigmatism, with a maximum corneal curvature of 83.95D. D The stromal cell structure in the superficial stroma was disorganized and in an activated state. E The central area of the corneal graft exhibited stromal thinning and anterior protrusion
See this image and copyright information in PMC

References

    1. Fujita A, Yoshida J, Toyono T, Usui T, Miyai T. Severity assessment of acute hydrops due to recurrent keratoconus after penetrating keratoplasty using anterior segment optical coherence tomography. Curr Eye Res. 2019;44(11):1189–94. - PubMed
    1. Bergmanson JP, Goosey JD, Patel CK, et al. Recurrence or re-emergence of keratoconus–what is the evidence telling us? Literature review and two case reports. Ocul Surf. 2014;12:267–72. - PubMed
    1. Koenig SB. Bilateral recurrent self-induced keratoconus. Eye Contact Lens. 2008;34(6):343–4. - PubMed
    1. Sahebjada S, Al-Mahrouqi HH, Moshegov S, et al. Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2021;259:2057–67. - PubMed
    1. de Azevedo MO, Gonçalves MC, Gatinel D. The role of environment in the pathogenesis of keratoconus. Curr Opin Ophthalmol. 2021;32:379–84. - PubMed

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