Early Findings of Keratoconus, Clinical Management, and the Challenge in Stopping its Progression

Background:Keratoconus (KCN) is considered a bilateral corneal ectatic disorder characterized by cone-like steepening of the cornea and irregular stromal thinning, which can lead to decreased visual acuity.This study aimed to assess the prevalence and risk factors for the KCN development in Kosovo.<br /> Methods and Results: This retrospective study was conducted in the Department of Ophthalmology at the University Clinical Center of Kosovo. The study included 131 respondents, with a total of 262 eyes. Keratometry basis parameters, such as flat keratometry (K1), and steep keratometry (K2), and maximal corneal curvature (Kmax) were determined. Corneal pachymetry was applied to measure the thickness of the cornea. Staging of KCN was done according to the adapted Amsler-Krumeich staging classification system (AK) for anterior data and corneal thickness (CT). Of 262 examined eyes, 240 (91.6%) were KCN eyes, 2 (0.8%) were suspect for KCN, and 20 (7.6%) were normal. KCN Stage 1 on the AK classification was predominant (P<0.001). KCN Stage 1 on the AK classification was predominant (52.9%) (P<0.001). We did not find a statistically significant difference between the mean age of patients and the KCN stage (P=0.235). The level of K1 was significantly lower in the non-KCN group (41.4 +/- 0.5 D) compared to KCN, and with increasing KCN stage, the K1 value significantly increased, reaching a maximum level in Stage 4 (53.3 +/- 4.3 D) (P=0.0000). A similar trend was typical for K2 and Kmax: from 44.7 +/- 5.1 D and 44.5 +/- 3.1 D, respectively, in the non-KCN group to 55.6 +/- 4.9 D and 65.3 +/- 8.3 D, respectively, in KCN Stage 4 (P=0.0000). Regarding the CT, the highest values were in the non-KCN group (504.0 +/- 27.6 mu m), gradually decreasing from KCN Stage 1 to Stage 4 (466.2 +/- 36.0 mu m vs. 378.6 +/- 95.0 mu m, P=0.0000).<br /> Conclusion: Screening programs that detect KCN at its earliest grade are the key to enabling early management, halting progression, and preserving the quality of visual acuity.