Epithelial remodelling masquerading as keratoconus progression: An interesting case report

Area of Science:

• Ophthalmology
• Corneal Diseases
• Regenerative Medicine

Background:

• Keratoconus is a progressive corneal ectasia requiring accurate monitoring.
• Topical trehalose eye drops are used for managing dry eye and potentially ocular surface diseases.

Observation:

• A 25-year-old male with diagnosed keratoconus showed apparent progression on Pentacam-HR after 8 months of trehalose eye drops.
• Advanced imaging (MS-39) revealed epithelial remodeling but no stromal or posterior elevation, suggesting pseudo-progression.

Findings:

• Topical trehalose application induced corneal epithelial remodeling in a keratoconus patient.
• This remodeling mimicked true keratoconus progression on specific imaging modalities.

Implications:

• Corneal epithelial remodeling should be considered a differential diagnosis for apparent keratoconus progression.
• Distinguishing pseudo-progression from true progression is crucial for appropriate treatment decisions.
• Further research is needed to understand trehalose's effect on corneal epithelium in keratoconus.