International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 8 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Pregnancy-associated New-onset Progressive Keratoconus with Horizontally Aligned Vogt's Striae in a 36-year-old Female

Daniel AR Scott, Graham Wilson, James McKelvie

Citation Information : Scott DA, Wilson G, McKelvie J. Pregnancy-associated New-onset Progressive Keratoconus with Horizontally Aligned Vogt's Striae in a 36-year-old Female. Int J Kerat Ect Cor Dis 2019; 8 (2):50-52.

DOI: 10.5005/jp-journals-10025-1183

License: CC BY-NC 4.0

Published Online: 01-12-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: The aim of the study is to report a case of pregnancy-associated progressive keratoconus with atypical horizontally aligned Vogt's striae. Background: Hormonal changes during pregnancy have been proposed as a risk factor for progressive keratoconus. There have been only a few cases of progressive keratoconus diagnosed with progression after pregnancy, without either an existing disease or an attributable cause. Case description: A 36-year-old New Zealand European woman presented with progressive myopic astigmatism following her first pregnancy. Stigmata of keratoconus were present on clinical examination and included horizontally aligned Vogt's striae. Tomography measurements confirmed the diagnosis with characteristic inferior corneal steepening and ectasia bilaterally. The patient was advised to abstain from eye rubbing, commenced topical olopatadine, and underwent corneal collagen cross-linking following delivery to prevent further keratoconus progression. Conclusion: Pregnancy-associated progressive keratoconus in a 36-year-old woman was documented after the pregnancy. Clinical significance: Atypical presentation features that include horizontally aligned Vogt's striae, advanced age at diagnosis, and rapid pregnancy-associated progression in a previously stable patient.

  1. Davidson AE, Hayes S, Hardcastle AJ, et al. The pathogenesis of keratoconus. Eye (Lond) 2014;28(2):189–195. DOI: 10.1038/eye.2013.278.
  2. Sharif R, Bak-Nielsen S, Hjortdal J, et al. Pathogenesis of keratoconus: the intriguing therapeutic potential of prolactin-inducible protein. Prog Retin Eye Res. 2018;67:150–167. DOI: 10.1016/j.preteyeres.2018.05.002.
  3. Soeters N, Tahzib NG, Bakker L, et al. Two cases of keratoconus diagnosed after pregnancy. Optom Vis Sci 2012;89(1):112–116. DOI: 10.1097/OPX.0b013e318238c3f2.
  4. Coco G, Kheirkhah A, Foulsham W, et al. Keratoconus progression associated with hormone replacement therapy. Am J Ophthalmol Case Rep 2019;15:100519. DOI: 10.1016/j.ajoc.2019.100519.
  5. Rabinowitz YS. Keratoconus. Surv Ophthalmol 1998;42(4):297–319. DOI: 10.1016/s0039-6257(97)00119-7.
  6. Naderan M. Ocular changes during pregnancy. J Curr Ophthalmol. 2018;30(3):202–210. DOI: 10.1016/j.joco.2017.11.012.
  7. Spoerl E, Zubaty V, Raiskup-Wolf F, et al. Oestrogen-induced changes in biomechanics in the cornea as a possible reason for keratectasia. Br J Ophthalmol 2007;91(11):1547–1550. DOI: 10.1136/bjo.2007.124388.
  8. Torres-Netto E, JB R, Hafezi N, et al. Late-onset progression of keratoconus after therapy with selective tissue estrogenic activity regulator. J Cataract Refract Surg 2019;45(1):101–104. DOI: 10.1016/j.jcrs.2018.08.036.
  9. Catenaccio E, Mu W, Lipton ML. Estrogen- and progesterone-mediated structural neuroplasticity in women: evidence from neuroimaging. Brain Struct Funct 2016;221(8):3845–3867. DOI: 10.1007/s00429-016-1197-x.
  10. Ferdi AC, Nguyen V, Gore DM, et al. Keratoconus natural progression: a systematic review and meta-analysis of 11 529 eyes. Ophthalmology 2019;126(7):935–945. DOI: 10.1016/j.ophtha.2019.02.029.
  11. Gaskin JCF, Good WR, Jordan CA, et al. The Auckland keratoconus study: identifying predictors of acute corneal hydrops in keratoconus. Clin Exp Optom 2013;96(2):208–213. DOI: 10.1111/cxo.12048.
  12. Gokul A, Patel DV, Watters GA, et al. The natural history of corneal topographic progression of keratoconus after age 30 years in non-contact lens wearers. Br J Ophthalmol 2017;101(6):839–844. DOI: 10.1136/bjophthalmol-2016-308682.
  13. Szczotka LB, Barr JT, Zadnik K. A summary of the findings from the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. CLEK Study Group. Optometry 2001;72(9):574–584.
  14. Grieve K, Ghoubay D, Georgeon C, et al. Stromal striae: a new insight into corneal physiology and mechanics. Sci Rep 2017;7(1):13584. DOI: 10.1038/s41598-017-13194-6.
  15. Sedaghat MR, Askarizadeh F, Narooie-Noori F, et al. Comparative evaluation of tomographic and biometric characteristics in bilateral keratoconus patients with unilateral corneal Vogt's striae: a contralateral eye. Clin Ophthalmol 2018;12:1383–1390. DOI: 10.2147/OPTH.S169266.
  16. Rakhshandadi T, Sedaghat MR, Askarizadeh F, et al. Refractive characteristics of keratoconus eyes with corneal Vogt's striae: a contralateral eye study. J Optom 2020;S1888-4296(20)30051-0. DOI: 10.1016/j.optom.2020.04.001.
  17. Chung SH, Kim EK. Keratoconus with unilateral horizontal stress lines. Cornea 2005;24(7):890. DOI: 10.1097/
  18. Güngör İ, Beden Ü, Sönmez B. Bilateral horizontal Vogt's striae in keratoconus. Clin Ophthalmol 2008;2(3):653–655. DOI: 10.2147/opth.s2573.
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