CLINICAL SCIENCE Clinical Profile and Risk Factors for Keratoplasty and Development of Hydrops in North Indian Patients With Keratoconus Reena Sharma, MD,* Jeewan S. Titiyal, MD,* Gaurav Prakash, MD,* Namrata Sharma, MD,* Radhika Tandon, MD, FRCOphth, FRCS(Ed),* and Rasik B. Vajpayee, MS, FRCS(Ed), FRANZCO*† Purpose: To review the profile of Indian patients with keratoconus and evaluate risk factors for keratoplasty and development of hydrops. Methods: In this prospective observational study, 120 consecutive patients with bilateral or unilateral keratoconus presenting to the cornea services of a large, tertiary care ophthalmic center were evaluated. A detailed history including information about the age at onset of symptoms, nature of ocular complaints, and so on was taken. Investigations included visual acuity, slit-lamp examination, kera- tometry, pachymetry, and videokeratography. Results: There were 76 males and 44 females (mean age at presenta- tion was 20.07 6 6.4 years). Five percent families revealed a positive family history. Earlier age at onset (P = 0.002) and eye rubbing (P = 0.02) were found significantly associated with increased risk for surgery. Eyes undergoing surgery had steeper corneas, lower best- corrected visual acuity, corneal scarring, and vernal keratoconjuncti- vitis were significant risk factors (P values: 0.001, 0.0001, and 0.04, respectively). Hydrops represents a significant independent risk factor for surgery (P = 0.0001). Patients with younger age at onset (P value 0.01), history of eye rubbing (P value 0.02), and atopy (P value 0.01) had higher risk for developing corneal hydrops. Conclusion: This knowledge of risk factors should enable clinicians and patients to make more informed decisions regarding the management of keratoconus. Key Words: keratoconus, surgery, hydrops, demography (Cornea 2009;28:367–370) K eratoconus is a progressive, paracentral thinning, and ectasia of the cornea. 1,2 Data on prevalence of keratoconus vary greatly in different studies. However, best estimates range from about 0.15% to 0.6% of the general population. 2,3 The disease often presents in second decade of life and then progresses at a variable rate. Most early studies showed a female preponderance. 4 However, more recent reports show no significant sex differences or a male preponderance. 3–6 It is considered a bilateral disease with onset at a mean age of 16 years. 2 Approximately 10%–25% of cases of keratoconus will progress to a point where vision correction is no longer possible, thinning of the cornea becomes excessive or scarring as a result of contact lens wear causes problems of its own, and a corneal transplantation becomes essential. 2–4 Very few studies have addressed the risk factors for keratoplasty and hydrops in these patients. 7–9 MATERIALS AND METHODS In this prospective observational study, 120 consecutive patients with keratoconus presenting to the cornea services of a large tertiary care ophthalmic center were evaluated. Informed written consent was taken from all the patients. The study was approved by the Academic and Research Committee, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, which is the Institutional Review Board of the Center. The study protocol followed all the tenets of the Declaration of Helsinki. Corneal ectasia secondary to other causes (trauma, post-laser in situ keratomileusis, pellucid marginal degeneration, and Terrien marginal degeneration) was excluded. Information about patients’ details (name, age, sex, religion, address, occupation, and domicile) was collected. A detailed history including information about the age at onset of symptoms, nature of ocular complaints, use of spectacles and contact lenses, any allergies (ocular and systemic), skeletal or rheumatoid diseases, ocular surgery, and consanguinity or similar history in any of the family members was taken. The age at which patients noticed ocular symptoms (frequent change of spectacles, poor acceptance of glasses, and signifi- cant ocular itching) requiring contact with an ophthalmologist was considered the age of onset. Visual acuity was estimated using early treatment diabetic retinopathy study (ETDRS) chart. Slit-lamp exami- nation was done to look for signs of keratoconus in anterior segment and conjunctiva (palpebral and bulbar). Keratometry Received for publication February 26, 2008; revision received May 25, 2008; accepted July 22, 2008. From the *Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and †Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia. Reprints: Gaurav Prakash, MD, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India (e-mail: drgauravprakash@gmail.com). Copyright Ó 2009 by Lippincott Williams & Wilkins Cornea  Volume 28, Number 4, May 2009 www.corneajrnl.com | 367 Copyright © 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.