Keratoconus is a disease that causes the cornea to change from spherical to conical shape. Keratoconus is a disease that manifests itself, inter alia, in astigmatism. However, it does not mean that every visually impaired person also has a cone. This disease is accompanied by other symptoms. So how do you recognize keratoconus? What are the treatments for keratoconus?

Corneal coneis a type of progressive ectasia disease involving the thinning of the cornea and its bulging in its central and peri-central part. This disease affects nearly 80,000 Poles.

The most common diagnosis of keratoconus is in the second or third decade of a patient's life. Early diagnosis and treatment implementation is very important as it gives a chance to maintain visual acuity and stop the progression of the cone.

An untreated cone can lead to severe visual impairment and a corneal transplant.

Keratoconus - what is it?

The cornea is the outer, transparent part of the eye, located in front of the colored iris. It is strongly innervated, but poorly supplied with blood. The natural shape of the cornea resembles a segment of a sphere, its surface is smooth.

In a cone - the cornea is deformed, visual acuity deteriorates, astigmatism and myopia increase. It is more and more difficult to choose glasses, eyes become sensitive to light, patients also complain of splitting and the "halo" effect.

Keratoconus: causes

The causes of keratoconus are both genetic and environmental. This disease often accompanies other diseases, such as :

  • atopic dermatitis
  • allergic conjunctivitis
  • retinal pigmented lesions

and also occurs in patients with Down syndrome or Marfan syndrome, in children of parents who have keratoconus themselves.

Keratoconus: Symptoms

The onset of a corneal deformity is difficult to capture. The first symptoms of keratoconus are usually redness and itching of the eye - these can be attributed to, for example, fatigue or allergy.

However, an interesting pattern has been observed - people who develop this keratoconus rub their eyes more frequently and vigorously, mostly using their wrists, while others usually do itwith your fingertips.

Over time, in addition to itching, photosensitivity reaction occurs, causing severe tearing, halo (glow around light sources), double vision and image distortion.

Most of all, however, your eyesight deteriorates quickly, which forces you to visit an ophthalmologist more often and change glasses, and finally it becomes impossible to choose them. Fortunately, you can then use other methods to improve your vision.

Keratoconus: diagnosis

The diagnosis of keratoconus is performed by performing a tomography of the cornea. Such examination shows the anterior and posterior surface of the cornea and allows for the detection of the cone at a very early stage of the disease.

Corneal tomography should be performed in every patient with progressive astigmatism and myopia.

Keratoconus: treatment

- When we diagnose a cone, we usually recommend cross-linking - says Dr. Łukasz Kołodziejski - cross-linking is a relatively short, painless procedure. As the only one, it is effective in inhibiting the progression of keratoconus, proven in many clinical studies.

The treatment consists of 2 or 3 stages, depending on its type. In the case of "epi-off" treatments, first the corneal epithelium is removed, and then the cornea is soaked with a special preparation containing riboflavin.

After soaking, which lasts 15-30 minutes, a lamp emitting UV-A radiation is placed above the eye, which, thanks to the presence of riboflavin, strengthens and hardens the structure of the cornea, which in turn stops the development of the cone.

The treatment is primarily aimed at stabilizing the disease, although in some patients we observe an improvement in visual acuity.

- For 2 years I have been using an innovative method of cross-linking, the so-called Megaride - says Dr. Łukasz Kołodziejski. - It differs from other versions of this treatment in that a special type of riboflavin is used. Thanks to this, we obtain satisfactory results without removing the corneal epithelium and in a relatively short, about 15-minute, exposure time. This procedure is also possible for children.

You have to wait up to six months for the effects of cross-linking. During this time, the collagen fibers in the cornea rebuild, new cross-links are formed and the cornea becomes elastic. The cone stops developing.

If the cone is not very advanced, a simultaneous laser defect correction combined with cross-linking is possible.

- In such a situation, we first perform a laser vision correction procedure, e.g. the EBK procedure - says Dr. Łukasz Kołodziejski - it must always be the so-called superficial, that is, consisting in taking off fromcorneal epithelium only.

In addition to EBK, we can also use the SmartSurf contactless method. Then we instill riboflavin and perform cross-linking.

Some patients undergo cross-linking first and laser correction a few months later.

After the cross-linking procedure, it is easier to choose contact lenses (hard, hybrid), which are standardly used to correct astigmatism and myopia in people with a cone.

There are other methods of correcting the vision defect in keratoconus, their task is to flatten the cone and are usually applied several months after cross-linking.

- If the thickness of the cornea allows, we can also correct astigmatism by grafting intracorneal rings - says Dr. Łukasz Kołodziejski - first we make tunnels in the cornea into which the rings are inserted. The procedure is aimed at "flattening" the cone and improving the quality of vision.

Corneal Transplant

In the event that treatment with other methods becomes impossible, a cornea transplant is the rescue.

The procedure takes 1-1.5 hours, it consists in removing the changed part of the cornea and sewing in a matched block of tissue taken from the recipient.

Transplant rejection is extremely rare (less than 1%).

Unfortunately, the recovery period is quite long (6-12 months) and usually requires avoiding exercise and taking immunosuppressive drugs on a permanent basis.

Worth knowing

In Poland, the first intracorneal ring implantation procedures were carried out in 2005 by prof. Iwona Grabska-Liberek. For the first few years, the tunnels were handcrafted by a surgeon. Today, they are normally prepared with a femtosecond laser.

The time of detection of the disease determines the effectiveness of keratoconus therapy. The more advanced the taper is, the more difficult it is to get good results, even when several procedures can be applied. Therefore, it is important to detect the disease in good time. A corneal tomography scan is painless, short, and gives your doctor a complete picture of your corneal he alth.

What do I need to know about keratoconus?

Keratoconus is a disease that causes the cornea to change from spherical to conical shape. How do you recognize a keratoconus? What are the treatments for keratoconus? Listen to our expert - Dr. Łukasz Kołodziejski from the LIBERMEDIC clinic.

Read also:

  • Viral eye keratitis
  • Pachymetry: corneal thickness test
  • Corneal transplant - how does a cornea transplant work in the eye?
About the author

Author: private archive

Łukasz Kołodziejski, PhD

Łukasz Kołodziejski, PhD

Specialist in the diagnosis and therapy of keratoconus and refractive surgery (laser vision correction, implantation of phakic lenses, refractive lens replacement) and cataracts.

Currently, he is a PhD student at the Medical Center of Postgraduate Education in Warsaw, and the research topic is modern methods of keratoconus treatment. The doctoral supervisor is prof. Iwona Grabska-Liberek. Dr. Łukasz Kołodziejski works at Libermedic - Warsaw Ophthalmology Center.

After numerous internships and trainings - incl. ESASO in Lugano on refractive surgery of the cornea and lens, diagnosis and treatment of keratoconus CXL Exprets Meeting in Zurich and training in laser vision correction organized by the Schwind company.

Category:

Eye diseases and vision disorders