Cone keratopathy is one of the toughest diseases in ophthalmology! Cone keratoconus is a non-inflammatory thinning disease characterized by a central or paracentral forward bulging of the cornea. The disease is common in young people, with 70% bilateral onset and a lower incidence in China than abroad. Although many scholars have studied cone corneas, the etiology is still unknown. Histologically, the cone was found to have fewer fiber layers, but the diameter of collagen fibers did not change, so it is thought that the thinning may be caused by insufficient bonding between the fiber layers, and the layers slipping away from each other. Genetic and allergic disorders are also possible causes. The progressive thinning of the central or paracentral area of the cornea leads to increased corneal irregularity, increased myopia, and progressive loss of vision, which seriously affects life, work, and study, and may lead to corneal perforation and blindness as the disease progresses. At present, it is usually corrected by rigid contact lenses, and in severe cases, a penetrating corneal transplant is done, and young people may need two corneal transplants in their lifetime. Clinical manifestations: The disease occurs in young people aged 16-20, more women, often involving one eye at the beginning, followed by the second eye onset, in the prognosis, the latter is better than the former. In the early stage, refractive error is predominant, starting with myopia and gradually developing into astigmatism or irregular astigmatism, which can be corrected by general lenses; 2. In the middle stage, visual acuity decreases further, which cannot be corrected by general lenses and must be corrected by contact lenses. Slit lamp examination shows that the central tip of the cornea gradually thins and protrudes forward, sometimes the posterior elastic layer ruptures, atrial water invades, and the corneal stroma can become edematous and cloudy; 3, in the late stage, the tip of the cornea often forms irregular linear scarring or clouding, and the superficial layer of the cornea has new blood vessels growing into it, with a high degree of visual acuity loss, and contact lenses cannot correct the vision. Diagnosis based on: 1, is a congenital anomalous eye disease, vision loss; 2, corneal apical thinning, conical bulge; 3, corneal curvature meter examination, often found irregular astigmatism, Prazidor corneal disc examination, concentric rings on the cornea become pear-shaped; 4, slit lamp examination, visible corneal cone apex after the elastic layer cracks, stromal clouding. Clinical staging: 1, latent stage: cone cornea is not obvious; if one eye has been diagnosed as cone cornea, the other eye should be considered as this disease when refractive error occurs. 2, early stage: refractive error is predominant, starting with myopia, gradually developing into astigmatism or irregular astigmatism, general glasses can correct the vision, Placido ring examination appears concentric rings of corneal images and the axis appears distorted. 3, completion stage: the emergence of typical cone corneal symptoms, vision further decline, general glasses can not be corrected, can only use rigid contact lenses to correct vision, four major clinical signs: 1) Munson’s sign: the affected eye downsight, corneal deformity by the lid margin curvature revealed; 2) Fleischer ring: iron deposits in the corneal epithelium; 3) Vogt line: appear in the posterior part of the corneal base layer, is vertical pressure line caused by increased folds in the corneal stroma; disappears when the eye is compressed. (4) Acute edema (acute cone) phase: acute rupture of the posterior elastic membrane and entry of atrial fluid into the cornea, resulting in acute edema and clouding of the stromal layer and epithelium. Severe rupture of the anterior elastic membrane is replaced by a fibrous tissue scar, and the scar, if on the visual axis, seriously affects vision! 4, degenerative stage: degeneration of the corneal subepithelium, formation of linear reticular scar in the center of the cornea, sharp decrease in visual acuity, hard contact lenses can no longer be corrected, and neovascularization in the superficial layer of the cornea. Clinical classification: grade 0: no cone cornea grade 1: slit lamp examination does not find cone cornea, with corneal curvature meter and retinal inspection, the mirror examination shows a cone cornea. Grade 2: increased concavity of the inner surface of the cornea, Vogt line, no corneal scar. Grade 3: Cornea with Vogt line and corneal scar, cone thinning. Grade 4: Patients with cone corneas undergoing corneal transplantation. Progressive cone cornea with slit lamp examination can be diagnosed and affect the patient’s vision, can not be corrected, that can confirm the diagnosis. Treatment principles: 1, early available lenses or corneal contact lenses to correct vision; 2, irregular astigmatism and central corneal clouding, corrected visual acuity below 0.2 feasible surgical treatment, such as lamellar corneal transplantation or penetrating corneal transplantation. ①Lamellar corneal transplantation: In recent years, due to the application of microsurgery and full-thickness corneal flaps without endothelium, lamellar corneal transplantation is preferred for patients with mid- to late-stage cone corneas, and better visual acuity is obtained after surgery, and the chance of rejection after corneal transplantation is lower! ② Penetrating corneal transplantation: When the conical cornea develops to late stage and the scar is serious, penetrating corneal transplantation should be taken. Nowadays, 7.5 to 8.5 mm diameter graft slices are mostly used. Because the transplantation piece is too large, postoperative immune rejection and comorbidities are more; if too small, the cone can not be corrected. 3, medication principles: postoperative systemic and local antibiotics, corticosteroids to prevent infection and anti-rejection reactions, supplemented by supportive therapy, oral cyclosporine if necessary.