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What is Keratoconus?
Keratoconus is a condition in which the cornea loses its normal shape and begins to bulge out into a cone-shaped shape (conus). Over time, the cornea begins to thin, irregular astigmatism (angles, astigmatism or siliconization) develops and eyeglass prescription changes occur. If left untreated, this condition can lead to vision loss and blindness.
What causes keratoconus?
The exact cause and mechanism of keratoconus are largely unknown. Keratoconus can run in families and can occur more often in people with certain health conditions. People with keratoconus who tend to rub their eyes frequently can make the condition worse. Keratoconus usually appears in the teens or twenties, but it can also start in childhood.
What are the symptoms of keratoconus?
Continued thinning of the keratoconus leads to continuous and successive changes in the prescription of eyeglasses and to irregular astigmatism (angles, astigmatism or astigmatism). These changes lead to a gradual decrease in vision, double vision, halos and light rays, distorted vision and myopia. These changes often lead to the inability to fit eyeglasses or contact lenses. Sometimes, if the cornea becomes too thin, a sudden swelling of the cornea develops due to the accumulation of water in it and sudden loss of vision.
How is keratoconus diagnosed?
Keratoconus can be diagnosed by an eye examination and imaging of the cornea. The imaging examination of keratoconus is called topography. In this examination, the curvature of the eye surface is measured and a colored “map” of the cornea is formed. Keratoconus causes clear and prominent changes in these maps, which can be easily detected. There is another examination called tomography, which is one of the latest technologies that can detect keratoconus earlier, even before changes in the corneal topography occur.
Our eye center has a very advanced device for diagnosing keratoconus called Pentacam. This device performs a cross-sectional imaging of the cornea and produces different maps to diagnose keratoconus. The device also knows how to determine the degree of keratoconus and can track the smallest changes.
How is keratoconus treated?
The two main goals in keratoconus treatment are:
The first goal is to stabilize the cornea and prevent the progression of the disease. This is achieved through a special, modern and advanced treatment in which the cornea is stabilized to prevent further corneal adhesions and further aggravation of the disease. The treatment is called Crosslinking.
This treatment is recommended for almost everyone diagnosed with keratoconus, depending on the patient's condition, corneal thickness and age. It is recommended to start this treatment early. It should be noted that this treatment does not correct vision, but it helps slow or stop the progression of keratoconus, and works to strengthen the bonds between the collagen fibers in the cornea and the surrounding proteins that can slow or prevent the cornea from thinning and curving further. Crosslinking treatment is a simple and safe procedure that can be performed without the need for an overnight stay in the hospital. Our eye center has the most advanced corneal crosslinking device in the world, the AVEDRO device. The device allows the procedure to be performed in the safest and fastest way. The procedure can be performed in a few minutes with a quick recovery and a high success rate. This procedure is performed under local anesthesia with anesthetic drops on the eye. The doctor drips drops of Vitamin B2 on the cornea and uses ultraviolet light to irradiate the cornea for no more than thirty minutes using the device. This procedure is short and very safe.
The second goal in treating keratoconus is to improve vision. Vision can be improved in keratoconus depending on the condition of the cornea, its thickness, angles, and degree of keratoconus. In the early stages of the disease, vision can be corrected with regular glasses or soft contact lenses. In more advanced cases, treatment to improve vision is rigid, semi-rigid, soft or hybrid contact lenses. For people who are not compatible with contact lenses, various types of intraocular lens implants can be performed. In severe cases, where contact lenses cannot be worn or if there are scars on the cornea, a corneal transplant is recommended.
Corneal transplantation for patients with keratoconus
Corneal transplantation is recommended in cases where vision cannot be corrected with glasses or contact lenses, or in cases where the cornea is very steep and thin, or in cases where scars appear on the cornea. There is a significant improvement in vision after a corneal transplant, although it may take more than a year for vision to stabilize. After the transplant, new glasses or contact lenses can be fitted if necessary. Some patients still need special contact lenses after a corneal transplant to get the best vision.
What types of corneal transplants are suitable for patients with keratoconus?
There are two main types of corneal transplants for patients with keratoconus. Based on the condition of your cornea, Dr. Orwa Nasser will advise you on the best type for you:
DALK: In this procedure, only the outer layers of the cornea are removed and replaced with a cornea from a human donor, while preserving the healthy and effective inner layers. Many studies show less rejection of the corneal transplant in this type of procedure compared to the PKP procedure.
PKP: The entire cornea is transplanted with a human donor cornea.
