Advances in keratoconus treatment

Abstract

Keratoconus is a noninflammatory, usually bilateral, progressive disease. It is a pathology characterized by a progressive thinning and ectasia of the stroma that results in a cone-shaped cornea. In advanced keratoconus with corneal opacities, keratoplasty was regarded as the only surgical alternative. Recently, new treatment alternatives were developed in keratoconus treatment, such as intracorneal ring segments and corneal crosslinking. Intracorneal ring segments act as spacer elements between the bundles of corneal lamellae, producing a shortening of the central arc length. Corneal crosslinking treatment increases the stiffness of the cornea. Several studies reported that collagen crosslinking can delay or stop keratoconus progression and produce a better quality of vision. A combination of crosslinking and intracorneal ring segments shows a positive, synergistic effect. Keratoconus is a disease of the corneal stroma and that usually presents itself in patients at an early age, thus the endothelial cell layer in eyes with keratoconus is young and almost healthy. Full-thickness penetrating keratoplasty has been a well-accepted surgical treatment for advanced keratoconus. Recently, great advances have been seen and new techniques of keratoplasty have been introduced in the treatment of keratoconus. These are mainly the lamellar keratoplasty techniques and the advanced shaped side-cut techniques, particularly with the use of femtosecond lasers.