Eyeworld

C JULY 2019 | EYEWORLD | 47 PRESENTATION SPOTLIGHT Contact information Torres-Netto: emilioatorres@me.com on corneal biomechanics, we all agree on the effect of age," Dr. Torres-Netto said. "As the cornea gets older, it gets stiffer and that's what makes our case interesting. We have a 49-year- old woman with bilateral stable keratoconus for 10 years, long-term stable BCVA and refraction, whose ectasia got worse, and was receiving no systemic or topical medications." After oral use of tibolone (2.5 mg/day) for 28 days and bilateral ovariectomies 17 days before, Scheimpflug image revealed a change in the corneal topography. Dr. Torres-Netto observed a flattening of the cornea, with Kmax 2.5 D lower in the patient's left eye. The right eye experienced a flattening of 1.2 D. Three months later, the patient complained about blurry vision. Her right eye had 20/20 but the left had 20/50 visual acuity. Dr. Tor- res-Netto noted a steepening of both corneas of up to almost 4 D. The Kmax was increased by 2.7 D in the right eye and by 3.8 D in the patient's left eye (Figure 1). Treating the ectasia The team decided to handle the corneal modi- fications observed in both eyes with the use of A published case report, 1 presented at the 23rd European Society of Cataract and Refractive Surgeons Winter Meeting, suggests that female keratoconus patients on tibolone (selective tissue estrogenic activity regulator [STEAR] therapy) need to be closely monitored. The report describes an association of rapid progression of keratoconus with STEAR therapy in the case of a 49-year- old woman. Ectasia worse despite increased age The patient began STEAR therapy for endo- metriosis. Roughly 4 months after initiating STEAR and 3 months after an ovariectomy, ectasia was increased in the eyes of the previ- ously stable patient. According to Emilio Torres-Netto, MD, who presented on behalf of his colleagues, estrogen may be one of the factors decreas- ing corneal biomechanical stability, along with pregnancy and hypothyroidism. Factors having the opposite effect include increasing age and tobacco smoking. "Although some of the evidence is weak for the effect that a number of these factors have Study links late-onset ectatic progression with estrogenic hormones by Stefanie Petrou Binder, MD EyeWorld Contributing Writer About the doctor Emilio Torres-Netto, MD Center for Applied Biotechnology and Molecular Medicine Ocular Cell Biology Group University of Zurich Zurich, Switzerland continued on page 48 Figure 1. Scheimpflug image showing progression of keratoconus until stable after approximately 4 months using tibolone Kmax 2.7 D Differential map (6 m–3 m) Kmax 3.8 D

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