Success Rates and Prognostic Factors in the Management of Keratoconus: A 10-Year Retrospective Cohort Study at Siriraj Hospital

Objective: To evaluate the success rates of different treatment modalities, identify prognostic factors associated with treatment outcomes and factors influencing disease progression in keratoconus patients. Materials and Methods: A retrospective cohort study of keratoconus patients at Siriraj Hospital during January 2013 to December 2023 was done. Patient characteristics, symptoms and signs related to keratoconus, outcomes of corneal topography, treatment modalities, and best-corrected visual acuity (BCVA) before and after treatment were recorded. Treatment outcome was defined as a “success” when the BCVA post-treatment was equal to or better than 6/12. Progression of keratoconus was based on the Belin ABCD progression criteria. Results: Total 119 patients (231 eyes) were analyzed. The mean age at diagnosis was 28.0 ± 9.5 years. Two hundred and sixteen eyes (93.5%) were clinical keratoconus. The overall success rate of all treatment modalities was 87.4%. Contact lenses were the most frequent treatment modality (147 eyes, 72.4%) with the highest success rate (90.5%). A worse initial BCVA, high keratometric reading and thinner cornea were risk factors for treatment failure in this group. Of 133 eyes disease progression could be evaluated (median follow-up time; 33 months) and 58 eyes(43.6%) met criteria for disease progression (median survival time; 8.8 years). No significant factors were found to be associated with disease progression. Conclusion: Success rate in keratoconus treatment at Siriraj Hospital was 87.4%. Contact lenses were most frequently applied 72.4%. Factors associated with treatment failure were found in this group but for disease progressionremained unclear due to limitations of the study.