Double Corneal Ring: Report of Simultaneous Coincidence of Kayser-Fleischer Ring and Fleischer Ring in a Keratoconus Patient Prior to Appearance of Wilson’s Disease

Purpose: To report a case of simultaneous bilateral Fleischer and Kayser-Fleischer rings two years prior to appearance of any sign, symptom or laboratory data of the Wilson's disease Case report: In this observational case report the examination and laboratory information of a 17-year-old Iranian female with blurred and decreased vision is introduced in a 2 years follow-up period. Complete ophthalmic examination, corneal topography, Orbscan corneal topography, laboratory tests [complete blood count (CBC), serum ceruloplasmin level, urine ceruloplasmin level, serum copper level, urine copper level] were done. Results: In slit-lamp examination Kayser-Fleischer (KF) and Fleischer rings along with a corneal inferior cone was revealed. The topography and Orbscan imagings confirmed the diagnosis of keratoconus (KCN). Patient did not suffer from any systemic sign or symptoms. Her systemic physical examination was normal. All laboratory tests (liver function tests, serum and 24 hours urine copper level, serum ceruloplasmin level) were within normal limits. After two years of followup, fine hand tremors started, so she was referred for more investigations to neurologists. They confirmed that the signs might be due to Wilson's disease central nervous system involvement. In her latest laboratory examinations, her serum ceruloplasmin level was reported beneath the normal limits. Conclusion: In our literature review there was no other resembling case in literature of coincidence of Wilson's disease and KCN. Hence we prefer to name it the first "double corneal ring" patient.