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Posterior segment alterations in keratoconus patients: an updated comprehensive review
Marrwan Hisham Mohmmed1, Renato Ambrósio2,3, Khosrow Jadidi4
1Department of Optometry, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Therapeutic Advances in Ophthalmology
|August 1, 2026
Summary
Keratoconus (KC) involves more than just the cornea, with new research showing significant changes in the retina, choroid, and optic nerve. These posterior segment alterations suggest a broader ocular remodeling process in keratoconus patients.
Area of Science:
- Ophthalmology
- Anterior Segment Diseases
- Posterior Segment Diseases
Background:
- Keratoconus (KC) traditionally viewed as an anterior segment disorder.
- Advanced imaging reveals significant posterior segment involvement in KC.
- This review synthesizes evidence on KC's impact beyond the cornea.
Purpose of the Study:
- To review structural and vascular changes in the posterior segment of KC patients.
- To explore alterations in the retina, choroid, macula, and optic nerve head.
- To challenge the anterior-centric view of KC and highlight systemic ocular remodeling.
Main Methods:
- Narrative review of over 40 peer-reviewed studies.
- Analysis of findings from optical coherence tomography (OCT), OCT angiography, and EDI-OCT.
- Synthesis of data on retinal, choroidal, macular, and optic nerve head morphology and vasculature.
Main Results:
- Consistent reports of retinal thickening, particularly in central/parafoveal regions.
- Documented reductions in vascular density, suggesting microvascular compromise.
- Increased choroidal thickness noted in pediatric and adult KC populations.
- Variable macular thickness findings; optic nerve head and RNFL alterations observed, especially in advanced cases.
Conclusions:
- Posterior segment changes challenge the traditional view of KC.
- KC may involve a more systemic ocular remodeling process.
- Further longitudinal studies are needed to clarify causality and therapeutic targets.
