Keratoconus is a relatively common corneal disorder (1 case per 500-2,000 people), which usually appears between ages 10 and 20. The cornea is the transparent tissue which forms the front part of the eye and under normal circumstances has a regular spherical shape. It is also the strongest lens in the human eye, and every disruption in its functioning and shape has a profound impact on the patient’s vision.
Keratoconus is the slow, often barely observable but progressive thinning and arching of the cornea in or near its centre. Vision gradually deteriorates, and, if not treated, keratoconus can lead to practical blindness.
The causes of keratoconus are not completely understood. Genetic factors and mechanical influences such as rubbing the eyes contribute to its development, and it occurs more frequently in connection with allergic diseases.
According to the degree of development and the severity of changes to the cornea, this disorder is divided into five categories: forme fruste keratoconus and keratoconus of degrees I-IV.
Until a few years ago, keratoconus treatment was restricted to corrective soft and hard contact lenses, and the next step was a corneal transplantation. Today, examinations and regular monitoring of the disorder’s progression with the help of modern diagnostic instruments not only allow for early diagnosis but also early commencement of appropriate treatment. For examinations, we mainly use optical tomography (Pentacam), topography, optical coherence tomography (OCT Visante) and aberrometry.
Treatment is administered according to the disorder’s state and progressivity, as well as the patient’s age and needs. Generally, the treatment goals are to halt the disorder’s progression and to rehabilitate vision. At the Lexum European Eye Clinic’s Keratoconus Centre, we have at our disposal all the methods which lead to this goal:
Collagen Cross Linking (CXL, CCL, C3-R)
Keraring intrastromal corneal ring segments (ICRS)
Conductive keratoplasty (CK)
Topography-guided photorefractive keratectomy (TG PRK)
Deep anterior lamellar keratoplasty (DALK)
Lamellar keratoplasty (LKP)
Penetrating keratoplasty (PKP)
Implantation of Visian intraocular contact lens (ICL)
Collagen Cross Linking is a modern method of treating keratoconus which was first used in the Czech Republic in 2005 by Lexum European Eye Clinic physicians. By strengthening the tissue, the cornea is stabilised and further progression of keratoconus is usually halted. If the disease has progressed to such an extent that it is impairing vision, we combine CXL with the implantation of Keraring intrastromal corneal ring segments into the cornea with the goal of flattening the arching cornea for keratoconus degrees I-III. In certain cases, to further adjust astigmatism, we use radio-frequency conductive keratoplasty or topography-guided laser correction of an irregular cornea – TG PRK.
If keratoconus has advanced to stage III or IV and the cornea is extremely arched, corneal transplantation is usually the only option. Normally, however, it is not necessary to transplant the full thickness of the cornea (PKP). In our centre we have at our disposal several techniques of so-called lamellar keratoplasty (LKP) corneal transplantation which make possible the more sparing replacement of only the damaged part of the cornea. This operation is performed with the help of the Amadeus system or the so-called “big bubble” technique.
In the next phase, it is possible to repair a dioptric vision defect by means of laser correction, most commonly using specialised PRK guided by a topographic map of the cornea. Another option is the implantation of a Visian permanent intraocular contact lens (ICL) or Artisan lens. For patients 45 and over, it is possible to correct the defect by replacing the patient’s own lens (RLE - Refractive Lens Exchange).
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