• Weiming Yan, Yanjin Chen, Xiaohong Chen, Qian Ye, Yutong Wang, Chuan Jiang, Xiangrong Zheng, Yunpeng Wang, and Meizhu Chen.
• Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou, China.
• Medicine (Baltimore). 2022 Jul 8; 101 (27): e29351e29351.

RationaleThe purpose of this report was to describe the diagnostic process of a case of keratoconus (KCN) after electrophysiological examination.Patient ConcernsA 23-year-old male army officer presented with decreased visual acuity (VA) in the left eye for 5 months. Best-corrected VA was 20/20 in the right eye and 20/300 in the left eye. The cornea and lens were clear in both eyes with a normal anterior chamber. No specific abnormalities were found on fundus photography, optical coherence tomography, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), or full-field electroretinography (ffERG) of both eyes. Pattern visual-evoked potentials (PVEP) detected a reduced amplitude and delayed peak time of the P100-wave in both eyes, which was more severe in the left eye. The amplitude and peak time of the P2-wave in flash VEP (FVEP) were comparable in both eyes and were within the normal ranges.DiagnosisCorneal topography was performed, and KCN was diagnosed by the presence of an asymmetrical bowtie pattern in both eyes, which was worse in the left eye.InterventionsTransepithelial corneal collagen cross-linking was performed.OutcomesThe BCVA of both eyes remained stable after treatment at follow-up.LessonsKCN should be suspected in cases of unimproved VA and significant irregular stigmatism, while no obvious lesions exist in other parts of the eyes. The evidence of lesion location by electrophysiological examinations could sometimes be of favor in diagnosing KCN.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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