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Keratoconus - what is it?

Keratoconus is not common, but if the disease is diagnosed, it must be treated immediately. Changing the shape of the cornea significantly worsens visual acuity and cannot pass by itself. Modern methods of treating keratoconus are effective and painless for the patient. Keratoconus is a serious eye disease characterized by progressive deformation and degenerative changes of the cornea of ​​the eye, leading to a significant decrease in vision.

Symptoms of keratoconus

Clinically, keratoconus is detected when the part of the cornea close to the center begins to thin out, because of this the curvature of the entire cornea changes, its surface protrudes forward and takes the form of a cone.

This is where the name of the disease comes from - keratoconus: kerato - cornea and konus - cone. Keratoconus is associated with a violation of the opto-mechanical properties of the cornea. The fibers that form its base lose their strength. In this regard, under the influence of even normal intraocular pressure, the cornea begins to protrude forward, assuming a conical shape. In areas of such protrusion, a thinning of the cornea of ​​less than 500 microns is formed. Due to a change in the corneal profile in Patients, the development of irregular astigmatism occurs, vision is reduced, which is not completely corrected by either glasses or contact lenses. These symptoms may appear in the early stages of the disease.

With the progression of keratoconus, cracks and tears occur in one of the inner membranes of the cornea with the formation of an eyesore, which leads to decreased vision. Moreover, with far-reaching keratoconus, a complete mechanical rupture of the cornea with the outflow of intraocular fluid, up to the anatomical death of the eye, is possible. That is why early diagnosis of keratoconus is so important to prevent the irreversible effects of the disease.

Causes of eye keratoconus

The etiology of this eye disease is still unclear. Among the reasons for the appearance of keratoconus, endocrine, hereditary, metabolic hypotheses are put forward that connect the onset of the disease with damage to the endocrine glands (for example, the thyroid gland), metabolic disorders (for example, a decrease in the activity of the antioxidant system). Also among the possible causes of keratoconus are called genetically determined immunological changes in the human body.

Diagnosis of keratoconus 

The most accurate methods to correctly diagnose and separate keratoconus of the eye from other possible lesions of the cornea include:

  • Computer keratometry (determining the curvature of the cornea)
  • Keratotopography (determining the relief of the cornea)
  • Pachymetry (determining the thickness of the cornea).
All these methods for diagnosing keratoconus are used in our clinic.

Treatment of keratoconus

Recently, the correction and treatment of keratoconus was limited to wearing Patient’s hard contact lenses until the progression of the disease caused marked thinning of the cornea, localized clouding, decreased visual acuity, persistent intolerance to contact correction and the impossibility of obtaining good visual acuity by wearing glasses . In this situation, an operation to conduct end-to-end keratoplasty (end-to-end corneal transplantation) was the only possible and correct tactic for the surgical treatment of the disease. However, now treatments for keratoconus have stepped forward.

Modern complex methods of treating keratoconus allow you to slow down, stop and, if possible, correct visual acuity in case of a disease without the need for complex corneal transplant surgery. 

Comprehensive treatment of keratoconus in the Eye Clinic of Dr. Belikova: a competent combination of modern techniques.

  • Crosslinking of corneal collagen with riboflavin (Vitamin B2 solution)
  • Implantation of intrastromal rings INTACT or Ferrarings using a femtosecond laser or mechanical keratoma 
  • Phakic (implantation of an additional crystalline lens)
  • Keratoplasty correction.

The advantages of these techniques are obvious. They give better results in the treatment of keratoconus compared to the previously used regimen. Thus, the question "How to treat keratoconus?" modern medicine gives a definite answer.

Crosslinking procedure for corneal collagen with riboflavin

Crosslinking is a new keratoconus treatment technique developed in Germany and Switzerland and is widely used in many leading European clinics. Using ultraviolet dosed radiation from a specially designed laser on the stromal (middle) layer of the cornea, it is possible to strengthen the corneal tissue and inhibit, if possible, stop the progression of keratoconus disease and avoid the need for corneal transplantation.

The crosslinking procedure is painless, performed on an outpatient basis, takes about 40-60 minutes in one eye. In the first phase of the procedure, special drops (riboflavin - a solution of vitamin B2) are instilled, containing the photosensitive component and saturating the middle layer of the cornea with it.

The second phase is the effect of the laser on the cornea saturated with this substance. As a result of the procedure, the cornea is “cemented” with strengthening of its structure, which slows down its further thinning and protrusion in the center. Thus, the progression of keratoconus stops and visual acuity remains stable. It is important to know that as a result of crosslinking, there is no improvement in visual acuity, the procedure is aimed only at strengthening the cornea, but not at the optical correction of keratoconus.

The effect of crosslinking lasts 4-5 years, after which it is necessary to repeat the procedure in some cases. To improve eye refraction and increase visual acuity, the crosslinking procedure can be combined with implantation of intrastromal half rings to obtain the effect of flattening the central part of the cornea. In cases of such combined treatment, good clinical results can be obtained with stabilization of the disease. Of great interest is the use of cross-linking to stabilize the cornea in Patients with progressive changes after a previous operation of radial keratotomy.

Implantation of intrastromal corneal segments (INTACS rings, Ferrarings)

Special polymeric rings are placed by the surgeon in the thickness of the cornea, into tunnels formed earlier using a femtosecond laser. The operation takes place under local drip anesthesia, lasts 10 - 15 minutes. Vision improvement occurs shortly after surgery. Implanted corneal segments create a reinforcing framework that prevents further curvature of the cornea of ​​the eye, while aligning it, thereby correcting (although not always completely) astigmatism.

Sometimes, to achieve the result, it is enough to implant one half-ring, sometimes two. The operation has a very high level of security, as it is non-penetrating and well tolerated by patients. In the postoperative period, the patient needs a few weeks to drip anti-inflammatory drops, and the half-ring takes root well in the cornea. In the initial stages of the disease, this type of operation is an excellent method to save the patient from the inevitable corneal transplant, to stop the development of keratoconus and to achieve good surgical correction of vision. In the presence of keratoconus and myopia, a double operation is performed - implantation of INTACS rings and a phakic lens, which allows for high visual acuity.

Implantation of phakic lenses 

Under local - drip anesthesia, a minimal corneal incision is made with a width of only 3.0 mm. An intraocular corrective lens is inserted through this incision and is inserted between the iris and lens, in the so-called posterior chamber of the eye. Since the incision is very small, suturing is not required at the end of the operation. The operation is performed on an outpatient basis and lasts about 10-15 minutes. The refractive result is comparable to using a conventional contact lens.

At the last stage of keratoconus, when the cornea not only changed its shape and thickness, but also became cloudy in the center, surgical treatment is shown - corneal transplantation. As practice shows, curing keratoconus these days is real, but, as in the case of many other eye diseases, timely treatment plays a paramount role in facilitating the treatment process, and especially for the Patient himself. At the Eye Clinic of Dr. Belikova, affordable prices are available for all methods of treating keratoconus.