Epithelial remodelling masquerading as keratoconus progression: An interesting case report

A 25-year-old male patient presented with chief complaints of itching in both eyes (OU) for the past one month. Detailed ophthalmic examination showed best-corrected visual acuity of 6/6 OU. On slit-lamp examination of the left eye, Vogt's striae were documented and rest of the anterior segment was normal OU. Pentacam-HR and ASOCT confirmed the diagnosis of keratoconus. The patient was started on Trehalose containing preparation for both eyes. On follow-up visit at 8 months, progression was documented on Pentacam-HR. MS-39 showed epithelial remodeling, but no stromal or posterior elevation, indicative of a pseudo-progression. Corneal epithelial remodeling post topical trehalose containing eye drops application has been very sparsely reported in literature. It is an important differential to consider when faced with a situation of a likely progression of keratoconus, especially to differentiate true from pseudo-progression.