Updates on Managements for Keratoconus

Abstract

PurposeKeratoconus is a progressive disease of the cornea which can lead to blindness as irregular astigmatism increases. Currently, a variety of methods are available for the treatment of keratoconus, and in certain cases, it may be difficult to choose the most appropriate option. This article reviews available treatment modalities for keratoconus to provide the practitioner with practical and useful information for selecting the most suitable option for each individual patient.MethodsTo review treatment methods for different stages of keratoconus, PubMed (United States National Library of Medicine) and Scopus (Elsevier BV) databases were searched using the keywords “keratoconus”, “contact lens”, “cross-linking”, “Intacs”, “keratoplasty”, “gene therapy”, and “irregular astigmatism”, and related articles were reviewed based on disease assessment parameters and treatment methods.ResultsVarious methods are available for the treatment of keratoconus: eyeglasses and contact lenses in the early stages, cross-linking for stabilizing disease progression, intrastromal corneal ring segments (ICRS) for reducing refractive errors or flattening the cornea, and penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK), conductive keratoplasty, gene therapy and more recently, bowman layer transplantation (BL transplantation) in advanced stages of the disease. To achieve optimum results, it is essential to choose the best option for each individual patient.ConclusionsA commonality of the reviewed papers was the advancement of novel diagnostic and treatment methods in ophthalmology, which can delay the need for corneal grafting. A better understanding of keratoconus treatment options can help enhance visual rehabilitation and prevent blindness in keratoconus patients.

Trends in Research Related to Keratoconus From 2009 to 2018: A Bibliometric and Knowledge Mapping Analysis

“…14 Corneal CXL is a novel invasive method for modifying the stromal structure of the cornea by increasing the formation of chemical bonds among collagen fibrils. 15 Wollensak 16 first reported the clinical study on the riboflavin-ultraviolet-A-induced corneal CXL procedure for the treatment of progressive keratoconus in adults. To analyze the long-term outcome of corneal CXL for progressive keratoconus, Raiskup et al 17 compared the mean apical keratometry value, the mean maximum K/minimum K values, and the corrected distance visual acuity after a 10-year follow-up of patients undergoing corneal CXL.…”

“…25 In keratoconus, ICRS implantation reduces corneal distortion by flattening the steep area of the cornea and reshaping it. 15 As for the insertion method of the ICRS, the canal can be created mechanically or with a femtosecond laser. Piñero et al 26 reported that higher order, spherical, and coma-like aberrations were significantly lowered when using the femtosecond laser-assisted method instead of the mechanical method.…”

Absence of the c.169+50delTAAACAG mutation of SOD1 gene in a sample of keratoconus patients in Brazilian population

“…At first, the disease manifests asymptomatically; however, with its progression, visual acuity decreases, culminating in the clinical picture of progressive myopia and irregular astigmatism which may last until the fourth decade of life. Severe cases of KC require corneal transplantation [1,3,7,12,14,[19][20][21].…”

Combined Protocols for Corneal Collagen Cross-Linking with Photorefractive Surgery for Refractive Management of Keratoconus: Update on Techniques and Review of Literature

“…Keratoconus is a bilateral corneal disease characterized by progressive but self-limited thinning and associated steepening of the central or paracentral cornea [3]. Reported prevalence rates range from 50 to 265 per 100,000, depending on a variety of environmental and genetic factors, but it remains the primary indication for corneal transplantation throughout most of the world (specifically, in Europe, Australia, the Middle East, Africa, and South America) [4–7]. While the pathophysiology of the disease remains elusive, alterations in stromal matrix collagen production and apoptosis of anterior stromal keratocytes are hallmarks of the disorder and trigger pathologic changes in corneal shape and biomechanics [8–11].…”