Inferior Spear-like Lens Opacity as a Sign of Keratoconus

Purpose: to report 21 cases of typical inferior feather-shape lens opacity associated with keratoconus. methods: in this cross-sectional study, we evaluated the association of keratoconus with inferior feather-shape lens opacity in refractive surgery candidates. visual acuity, demographic, refractive, and topographic characteristics of 26 eyes of 21 patients with inferior feather-shape lens opacity were evaluated in detail. pedigree analysis was also performed to assess possible inheritance. results: overall, 2122 out of 33,368 cases (6.4%) without lens opacity had keratoconus, while 20 out of 21 patients (95.2%) with peculiar lens opacity had definite keratoconus (p < 0.001). lens opacity was bilateral in 5 cases (24%), and keratoconus was bilateral in all 20 patients with lens opacity. nine eyes out of thirty-six with a complete data record (25%) had a severe keratoconus and underwent deep lamellar keratoplasty, while 11 (31%) had forme fruste keratoconus. pedigrees were drawn for eight patients, most families of whom suggested an x-linked recessive inheritance. conclusion: the present study was the first to investigate patients with a peculiar inferior feather-shape lens opacity accompanied by bilateral keratoconus, whichwas observed in 95% of the patients. this finding should raise awareness as tothe possibility of diagnosing keratoconus in the eyes of the patients with thesecharacteristics.