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Treatment of Keratoconus: Things You Should Know!


Date :28-Dec-2018

Keratoconus is a non-inflammatory, progressive, degenerative disorder characterised by thinning of the cornea – central or paracentral cornea starts to bulge and become cone-shaped instead. This process of thinning and re-shaping is termed corneal ectasia. This can make your vision distorted and blurry, as light being focused by your cornea forms an imprecise image on your retina, at the back of your eye. As keratoconus advances, it results in irregular astigmatism, and scarring begins to take place on the exposed high points of the cornea. This leads to a progressive but obvious reduction in best-corrected visual acuity (BCVA), with low-contrast visual acuity (VA) declining more rapidly than high-contrast VA.

This is a relatively common disorder of unknown etiology and most likely multifactorial. Many experts think that genetics plays a vital role. The term Keratoconus is actually a Greek word (kerato- idis: Cornea; konos: Cone), meaning cone-shaped extension of the cornea. Keratoconus is a common disorder with a reported prevalence ranging from 50 to 200 per 100,000. Keratoconus is generally first diagnosed during the teens to early 20s, but it can be unpredictable in how fast it progresses. It is significant to keep in mind that to avoid rubbing your eyes as this can contribute to the progression of the disease.

Symptoms:

  • unusually increased sensitivity bright light
  • Distorted vision at all distances
  • Ghost images – the appearance of partial, incomplete image or multiple images when looking at one object
  • Poor night vision (diplopia)
  • unexpected or abrupt loss of clarity of vision (visual acuity)
  • Noticeably worse vision in one eye
  • Double vision in one eye
  • corneal blisters that cause swelling of the cornea due to fluid accumulation (acute corneal hydrops)

Treatment

Depending on the severity of the condition, there are several ways to treat keratoconus

Soft astigmatism contact lenses: They have a significant role in the mild and the early stages of keratoconus. Most toric contacts are specially designed soft contact lenses to correct astigmatism (imperfection in the curvature of your eye's cornea or lens). The lens is soft, but it has different powers in different meridians of the lens to correct the varying amount of nearsightedness or farsightedness.

Rigid gas permeable contact lenses: In moderate stages of keratoconus, a rigid gas permeable lens is used and they have been the stronghold for contact lens correction of keratoconus for many decades. Made of oxygen permeable rigid materials and are typically of a size that is smaller than the overall corneal diameter, the rigid gas permeable lens provides a hard surface, so that any corneal distortion may be suppressed.

Hybrid contact lenses: Hybrid contact lenses have a central lens made out of rigid gas permeable lens center and a soft lens “skirt”. The rigid lens provides the vision correction and the soft skirt provides exceptional lens centration and enhanced comfort. They are available in specialty designs and fitting methods to address keratoconus.

Scleral contact lenses: Scleral contact lenses are large diameter rigid gas permeable lenses and vaults the entire cornea (do not touch the corneal surface at all) and overlap onto the sclera (the white part of the eye). A scleral lens provides very good lens comfort and it also protects the corneal surface from the negative effects of contact lens bearing.

Corneal cross-linking: Corneal cross-linking is a minimally invasive outpatient procedure of the oxidative cross-linking of collagen in the corneal stroma to help strengthen cornea in the process. This corneal collagen cross-linking with riboflavin, also called CXL for short, strengthens and stabilizes the cornea by creating new links between collagen fibers within the cornea. The two-step procedure applies liquid riboflavin (vitamin B2) to the surface of the eye and then an ultraviolet light is applied to the eye to solidify the process.

Corneal cross-linking typically reduces the steepening of the cornea and that could potentially save your sight, especially if you are treated early on. Even for those who are treated later on, it halts the worsening of their condition and prevents the need for a corneal transplant. CXL also can be combined with other procedures for keratoconus treatment.

There are two basic types of corneal cross-linking:

  • Epithelium-off CXL: EPI -off cross-linking procedure involves the removal of the corneal epithelium to allow the liquid riboflavin to more easily penetrate the corneal tissue.
  • Epithelium-on CXL: This procedure is also called transepithelial CXL. The protective corneal epithelium is left intact which requires a longer riboflavin "loading" time but it helps to avoid other CXL-associated adverse events.

Best candidates for corneal cross-linking:

Corneal cross-linking is most effective if it can be performed before there is significant vision loss from keratoconus or other causes of corneal ectasia or the cornea has become too irregular in shape. When performed early, CXL typically will stabilize or even improve the shape of the cornea, resulting in better visual acuity and an improved ability to wear contact lenses. Other potential applications of CXL include the treatment of corneal ulcers that are unresponsive to topical antibiotics and they can be effective for eradicating a variety of corneal infections.

Keratoconus Surgery

A corneal transplant (keratoplasty) may be required for severe cases of keratoconus. There are two basic types of keratoplasty: conventional, full thickness cornea transplant (also known as penetrating keratoplasty, or PK) and back layer cornea transplant (also known as endothelial keratoplasty, or EK). For keratoconus, PK has historically been the surgery of choice but currently lamellar techniques are the gold standard for patients with mild to moderate disease. In recent times, a newer version of corneal transplant surgery called endothelial keratoplasty (EK) has been introduced which replaces only the innermost layer of the cornea (endothelium) and leaves the overlying healthy corneal tissue intact.

Neera Eye Center is one of the leading eye care hospitals in New Delhi, offering state-of-the-art modern diagnostic, therapeutic, and rehabilitative services of the highest quality in ophthalmology.

Doctors at Neera Eye Center are dedicated in providing better vision by interfacing cutting edge technology with the treatment modalities meeting International Standards. The Eye Center offers all-inclusive patient care, vision enhancement and rehabilitation services. Treatments offered include C3R treatment for Keratoconus, Keratoconus Surgery in Delhi, Cataract Surgery ( Phacoemulsification), LASIK, YAG Laser Treatment, Corneal transplant, Contact lenses, ICL Surgery, INTACS, Glaucoma Surgery, Squint Surgery, Limbal Stem Cell Transplant ( SLET)

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