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keratoconus · anterior-segment

Keratoconus — Clinical Specification

Anterior Segment · Corneal Ectasia · Last reviewed Feb 2026

Stage IIProgressive

Condition

Keratoconus (KCN)

Progressive, non-inflammatory ectatic disorder of the cornea characterized by stromal thinning and anterior protrusion.

ICD-10

H18.60

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Keratoconus, unspecified. Stage-specific codes: H18.601 (Stage I) through H18.604 (Stage IV) per Amsler-Krumeich grading.

Amsler-Krumeich Stage

Stage II (Moderate)

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K-reading 48–53 D. Corneal scarring absent. Refraction: myopia/astigmatism >5 D. Pachymetry >400 μm. Fleischer ring may be present.

Topographic Pattern

Inferior Steepening

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Classic inferior steepening on axial map. KISA% index >100%. I-S value >1.4 D. Cone location: inferonasal 68%, central 21%, other 11%.

Simulated K Readings

Flat: 44.5 D / Steep: 51.2 D

Irregular astigmatism axis typically oblique. SimK difference >1.5 D from fellow eye is diagnostic flag. Monitor for progression ≥1.0 D/year.

Pachymetry (Thinnest)

432 μm

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Thinnest point typically displaced inferiorly from apex. Values <400 μm indicate advanced disease. Contraindication for LASIK < 500 μm.

Management

Rigid Gas-Permeable / CXL

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Mild: Spectacles or soft toric. Moderate: RGP or scleral lens. Progressive: Corneal Collagen Cross-Linking (CXL). Advanced: DALK or PKP.

Differential Diagnosis

3 conditions to consider

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1. Pellucid Marginal Degeneration (inferior thinning, crab-claw pattern) 2. Keratoglobus (generalized thinning) 3. Posterior Keratoconus (posterior surface ectasia only)

12 citations · AAO, AAOE, BCLA guidelines

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Pacific Vision Institute — San Francisco, CA

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