Clinical characteristics and management strategies of keratoconus in iraqi patients

Purpose The aim of this study was to investigate the clinical characteristics, refractive error profile, and management approaches in Iraqi patients diagnosed with keratoconus (KC), emphasizing the disease severity, sex distribution, and visual outcomes. Patients and methods A retrospective study was conducted on 405 eyes of 405 patients diagnosed with KC at Ibn Al-Haytham Teaching Eye Hospital, Baghdad, Iraq, between January 2022 and January 2025. The collected data included age, sex, KC severity (classified by keratometry), refractive error type and axis orientation, treatment modality (optical or surgical), and uncorrected and best-corrected visual acuity. Results Most patients (57.28%) were females and aged 21–30 years (43.46%). Mild and moderate KC accounted for 38.77 and 32.35% of the cases, respectively. Oblique compound myopic astigmatism was the most prevalent refractive error (42.47%), followed by with-the-rule compound myopic astigmatism (26.67%). Rigid gas-permeable and scleral lenses were the most common treatments used (34.57 and 32.10%, respectively), while 24.69% of the patients underwent corneal collagen cross-linking and 18.52% required surgical intervention. The visual acuity improved significantly after treatment, with 40.99% of the eyes achieving 6/6 best-corrected visual acuity and fewer than 10% remained below 6/18. Conclusion KC in this Iraqi cohort demonstrated a female predominance and a high frequency of oblique compound astigmatism, particularly in early disease. Stage-specific treatment strategies effectively restored the visual function, including early contact lens fitting and collagen cross-linking. These findings support the need for early detection and access to tailored interventions in low-resource settings.