title: Thick keratoconic cornea associated with posterior polymorphous corneal dystrophy.
abstract: BACKGROUND
  We herein report a case of bilateral unusually thick non-edematous keratoconic corneas with associated endothelial features of posterior polymorphous corneal dystrophy (PPCD).
  
  
  METHODS
  We report the case of a 27-year-old myopic woman who presented for refractive surgery. Slit lamp exam showed bilateral corneal protrusion with diffuse deep stromal and endothelial vesicular opacities and small paracentral bands. Topography showed generalized advanced corneal steepening in both eyes with increased anterior and posterior central corneal elevations in comparison to the best fit sphere. Ultrasound pachymetry showed central corneal thickness of 605μm (RE) and 612μm (LE). On specular biomicroscopy, cell density of 2503 cells/mm2RE and 1526 cells/mm2LE with significant cellular pleomorphism and polymegathism were noted.
  
  
  CONCLUSIONS
  Clinical and paraclinical findings together suggest the presence of simultaneous keratoconus and PPCD. The literature has suggested an association between PPCD and steep cornea. Moreover, many reports have also described cases of associated PPCD and keratoconus with characteristic thinning and ectasia, in comparison to the unusual thick corneas noted in our patient, despite the absence of edema. Identification of genetics factors is further needed to clarify this association.
  
  
  CONCLUSIONS
  This case describes a patient whose corneas present features of both keratoconus and PPCD and is unique due to the presence of increased corneal thickness despite the absence of edema.
authors.affiliation: Ophthalmology department, Hôtel-Dieu de France, Saint-Joseph University (USJ), faculty of medicine, Alfred Naccache Street, Achrafieh, Beirut, Lebanon.
authors.forename: K
authors.initials: K
authors.lastname: Zaarour
authors.affiliation: Ophthalmology department, Hôtel-Dieu de France, Saint-Joseph University (USJ), faculty of medicine, Alfred Naccache Street, Achrafieh, Beirut, Lebanon.
authors.forename: E
authors.initials: E
authors.lastname: Slim
authors.affiliation: Ophthalmology department, Hôtel-Dieu de France, Saint-Joseph University (USJ), faculty of medicine, Alfred Naccache Street, Achrafieh, Beirut, Lebanon. Electronic address: joelle.antoun@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Antoun
authors.affiliation: Ophthalmology department, Hôtel-Dieu de France, Saint-Joseph University (USJ), faculty of medicine, Alfred Naccache Street, Achrafieh, Beirut, Lebanon.
authors.forename: N
authors.initials: N
authors.lastname: Waked
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology*; D003317:Corneal Dystrophies, Hereditary / Q000150:complications* / Q000473:pathology*; D063171:Corneal Pachymetry; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000209:etiology* / Q000473:pathology*
keywords: Cornée épaisse; DMLA; Keratoconus; Kératocône; PPCD; Thick cornea