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Keratoconus

Keratoconus

This disorder is a

  • Progressive ,Central and paracentral thinning and steepening of the cornea
  • Occurs in 5- 20% ( 1 per 2000)
  • Seen in the Second decade of life (teenagers-adults in their 20s)
  • Arises when the middle of the cornea thins and gradually bulges outward, forming a rounded cone shape. Affecting both eyes.
  • This abnormal curvature changes the cornea's refractive power
    • producing moderate to severe distortion (astigmatism) and blurriness (nearsightedness) of vision.
    • Blurring of vision
    • Ghost images
    • Prescription changes – increasingly frequent intervals
    • Normal Cornea & Keratoconus
  • Various proposed associations and causes as per various studies
    • An inherited corneal abnormality. About seven percent of those with the condition have a family history of keratoconus.
    • An eye injury, i.e., excessive eye rubbing or wearing hard contact lenses for many years.
    • Certain eye diseases, such as retinitis pigmentosa, retinopathy of prematurity, and vernal keratoconjunctivitis.
    • Systemic diseases, such as Leber's congenital amaurosis, Ehlers-Danlos syndrome, Downs syndrome, and osteogenesis imperfecta.
  • Diagnosis based on
    • Clinical Signs
    • Corneal topography- Pentacam
    • Wavefront Analysis
  • Treatment
keratoconus
treatment
1. Contact lens

a) Rigid Gas Permeable contact lenses.(RGB)- Replace irregular shape with smooth and uniform refracting surface

2. Intacs: Semicircular PMMA devices implanted into corneal stroma

a) Principle : volume is added to corneal periphery or removed from centre , leading to flattening of central cornea thus ,reducing corneal power

Contact lens

 


3. C3R (Corneal Collagen Crosslinking with Riboflavin) The latest revolutionary Keratoconus treatment is C3R (Corneal Collagen Crosslinking with Riboflavin)

 


C3R
Contact lens

 


a) Mechanism: To strengthen the weak corneal structure by increasing collagen crosslinking, which are the natural "anchors" within the cornea.

b) The C3R treatment is performed in just 20 TO 30 minutes.

c) During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet light.. The yellow pigment of the Riboflavin absorbs the Ultraviolet A light, increases the amount of collagen cross-linking in the cornea and strengthen the cornea..

d) Once the procedure is completed, a soft bandage contact lens will be placed in the eye and antibiotics will be instilled. The contact lens will be removed in one or two days.

e) A satisfactory result will be arresting the progress of keratoconus.

Contact lens

 


C3R causes the collagen fibrils to thicken, stiffen, and crosslink & reattach to each other, making the cornea stronger and more stable & halting the progression of the disease

Adavantages of C3R
  • Simple non invasive treatment
  • Halts the progress and causes some regression
  • No handling of lenses every day
  • No stitches
  • No incisions
  • Quick recovery

 

PRK with Schwind ESIRIS Excimer Laser and C3R Treatment in Keratoconus Patients in the Same Sitting

Collagen cross-linking (C3R), though established primarily as a tectonic procedure for eyes with keratoconus, has also been found to have a relatively predictable refractive outcome, albeit of a small magnitude.1 Photorefractive keratectomy (PRK), as against laser in situ keratomileusis, is a relatively safe refractive procedure for eyes with keratoconus with thin corneas, more so if corneal ablation is performed to undercorrect the refractive error. The residual refractive error could then be eliminated by the C3R process, when applied upon the bed of ablated corneal tissue. The purpose of our study was thus to determine whether a small optic zone (5.5 mm) photorefractive keratectomy along with collagen cross linking could be combined in a single procedure in terms of predictability of refractive outcome and safety in eyes with keratoconus.

 

5. Penetrating kertoplasty/ Corneal transplantation
  • Indications Large cones with progressive thinning and scarring ,where other treatment modalities are not possible., Severe keratoconus
  • Full thickness corneal transplation or Partial thickness transplantation(DALK)
cornea transplantation