Professor Yonca Aydın AkovaProfessor Yonca Aydın Akova Ophthalmologist and Eye Surgeon

What is Keratoconus?

What is Keratoconus?

What is Keratoconus?

Keratoconus is a progressive eye condition in which the cornea, the clear front surface of the eye, becomes thinner and weaker, causing it to bulge outwards into a cone shape. This abnormal shape of the cornea can cause vision distortion, including nearsightedness, astigmatism, and irregular astigmatism. Keratoconus usually affects both eyes, although one eye may be more severely affected than the other. It typically begins in adolescence or early adulthood and can progress slowly over several years. In severe cases, the cornea may become scarred, leading to further vision loss..

Keratoconus can be diagnosed with a comprehensive eye exam, including corneal topography and other specialized tests, and it can be managed with glasses, contact lenses, or in some cases, corneal surgery.

What are the clinical features of keratoconus?

The clinical features of keratoconus may include:

  1. Blurred or distorted vision: The bulging and irregular shape of the cornea can cause blurred or distorted vision, making it difficult to see clearly.
  2. Increased sensitivity to light: People with keratoconus may experience increased sensitivity to light or glare, making it uncomfortable to be in bright environments.
  3. Progressive astigmatism: The irregular shape of the cornea can cause astigmatism, which can worsen over time.
  4. Near-sightedness (myopia): In some cases, keratoconus can cause near-sightedness in addition to astigmatism.
  5. Corneal thinning: As the disease progresses, the cornea can become thinner, leading to a condition called corneal ectasia, which can further compromise vision.
  6. Visual distortion: People with keratoconus may experience visual distortion, such as seeing multiple images or halos around lights.
  7. Eye rubbing: Frequent eye rubbing can exacerbate the thinning of the cornea and worsen the keratoconus.

It is important to note that the symptoms of keratoconus can vary from person to person, and the disease can progress at different rates. If you are experiencing any vision problems, it is important to see an eye doctor for a comprehensive eye exam.

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What is differential diagnosis for keratoconus?

There are several eye conditions that may mimic the clinical features of keratoconus, and thus may be included in the differential diagnosis. These include:

  1. Pellucid marginal degeneration: This is a rare corneal condition that can also cause corneal thinning and bulging, leading to similar clinical features as keratoconus.
  2. Post-LASIK ectasia: This is a condition that can occur after LASIK surgery, where the cornea becomes thinner and bulges, causing similar visual symptoms and clinical features as keratoconus.
  3. Terrien’s marginal degeneration: This is another rare corneal condition that can cause thinning of the cornea, but typically occurs in older individuals.
  4. Corneal hydrops: This is a complication of advanced keratoconus, where the cornea suddenly swells and causes significant visual impairment.
  5. Fuchs' endothelial dystrophy: This is a progressive condition that affects the cells lining the inner layer of the cornea, leading to visual symptoms such asblurred vision, glare and halos.
  6. Contact lens warpage: This can occur with improper use or fitting of contact lenses, leading to changes in the shape of the cornea and visual symptoms similar to keratoconus.

It is important to see an ophthalmologist for a comprehensive eye exam if you are experiencing any visual symptoms or changes in your eyes, as proper diagnosis is key for effective treatment.

How is keratoconus diagnosed?

Keratoconus is typically diagnosed through a comprehensive eye exam, which may include the following tests:

  1. Visual acuity test: This measures how well you can see at various distances, using an eye chart.
  2. Refraction test: This determines your eyeglass prescription, which may reveal nearsightedness, farsightedness, or astigmatism.
  3. Slit-lamp examination: This uses a microscope with a bright light to examine the front of the eye, including the cornea, iris, and lens.
  4. Dilated eye exam: This involves using eye drops to dilate the pupils, which allows the eye doctor to examine the retina and optic nerve.
  5. Keratometry: This measures the curvature of the cornea, which can also help detect corneal irregularities and thinning.
  6. Pachymetry: This measures the thickness of the cornea, which is important in diagnosing and monitoring keratoconus.
  7. Corneal topography: Corneal topography is a common tool used in the diagnosis and management of keratoconus.This measures the shape of the cornea using a special instrument called a topography, which can help detect corneal irregularities, thinning and keratoconus.Topographic analysis can detect early signs of keratoconus, monitor its progression, and aid in the selection of treatment options.
  8. Scheimpflug imaging (three dimensional corneal tomography)is a technique that uses a rotating camera to capture images of the anterior segment of the eye.It provides information about corneal thickness, curvature, and elevation, as well as other parameters of the eye.Scheimpflug imaging has been shown to be useful in the diagnosis and monitoring of keratoconus, and in the selection of treatment options
  9. Optical Coherence Tomography (OCT)is an imaging technique that uses light waves to produce high-resolution cross-sectional images of the eye.It can be used to measure corneal thickness, epithelial thickness, and other structural parameters of the eye.OCT has been shown to be useful in the diagnosis and monitoring of keratoconus, and in the evaluation and follow-up of corneal cross-linking treatment

If keratoconus is suspected, the eye doctor may also perform tests, such as corneal topography, three dimensional corneal tomography or optical coherence tomography (OCT),which can provide more detailed images of the cornea and help monitor the progression of the disease over time.

It is important to see an eye doctor if you are experiencing any visual symptoms or changes in your eyes, as early detection and diagnosis are key for effective treatment and management of keratoconus.

What is the gold standart for screening keratoconus?

The gold standard for screening and diagnosing keratoconus is a comprehensive corneal evaluation, which may include corneal topography and tomography. Corneal topography is a non-invasive imaging test that uses computerized mapping to create a three-dimensional model of the cornea. This test can detect early signs of corneal thinning and distortion, which are characteristic of keratoconus. Corneal tomography is a more advanced form of topography that provides more detailed images of the cornea, including thickness and curvature measurements.

Additionally, the use of a Scheimpflug camera, a type of imaging technology that provides 3D images of the cornea, has also been shown to be an effective screening tool for keratoconus. This technology allows for the detection of subtle changes in corneal shape and thickness, which can be indicative of early-stage keratoconus.

It is important to note that the diagnosis of keratoconus is based on a combination of clinical findings, including corneal imaging, visual acuity, and refraction testing. A comprehensive evaluation by an eye doctor is necessary for accurate diagnosis and appropriate management of this condition.

When does keratoconus begin and what is the age range?

The age of onset of keratoconus can vary, but it typically starts in adolescence or early adulthood, usually between the ages of 10 to 25 years old. However, keratoconus can also start in childhood or later in life, although this is less common.

The age range for keratoconus onset is therefore quite wide, ranging from childhood to middle-aged individuals. It is important to note that keratoconus is a progressive condition that can worsen over time, so early detection and treatment are crucial for preserving vision.

Can keratoconus affect only one eye?

Keratoconus can occur in one or both eyes and typically develops during adolescence or early adulthood. When keratoconus is present in only one eye, it is referred to as unilateral keratoconus.

Unilateral keratoconus can cause a variety of visual symptoms, including blurred vision, distorted vision, and sensitivity to light. The degree of visual impairment can vary depending on the severity of the condition, with some patients experiencing only mild symptoms while others may have significant visual impairment.

Diagnosis of keratoconus typically involves a comprehensive eye exam, including a visual acuity test, corneal topography, and measurement of corneal thickness. Treatment options for unilateral keratoconus may include eyeglasses or contact lenses to correct vision, as well as corneal cross-linking to help prevent further progression of the disease.

In some cases, surgery may be recommended to improve vision, such as implantable contact lenses or corneal transplant. The choice of treatment will depend on the severity of the condition, the patient's age, and other factors such as the shape and thickness of the cornea.

Overall, the management of unilateral keratoconus requires careful evaluation and monitoring by an experienced eye care professional to ensure that the condition does not progress and to optimize visual acuity. Regular eye exams and adherence to prescribed treatments can help minimize the impact of keratoconus on vision and overall quality of life.

What are the stages of keratoconus?

Keratoconus is a progressive eye condition that can cause changes to the shape and structure of the cornea. The severity of the condition can vary, and it is often classified into different stages based on the degree of corneal distortion and thinning.

The most commonly used system for staging keratoconus is the Amsler-Krumeich classification, which divides the condition into four stages based on the degree of corneal thinning and protrusion. The stages are as follows:

  1. Stage 1: In the early stages of keratoconus, the cornea may begin to thin and develop small irregularities. Visual acuity is usually still good at this stage, and glasses or contact lenses may be used to correct any vision problems.
  2. Stage 2: As the condition progresses, the cornea becomes more distorted and may begin to bulge outward. Vision may become more blurry, and contact lenses may be needed to correct vision problems.
  3. Stage 3: In this stage, the cornea becomes significantly thinner and more distorted, causing significant visual impairment. Glasses or contact lenses may not be effective at correcting vision, and more specialized treatments such as corneal cross-linking or corneal transplant may be needed.
  4. Stage 4: This is the most advanced stage of keratoconus, where the cornea becomes extremely thin and cone-shaped, leading to severe visual impairment or even blindness. Corneal transplant is often the only option for improving vision at this stage.

It is important to note that not all patients will progress through all stages of keratoconus, and the severity and rate of progression can vary widely between individuals. Regular eye exams and monitoring by an eye care professional can help identify and manage keratoconus at an early stage, which can help prevent further vision loss and improve treatment outcomes.

What is the cause of keratoconus?

Keratoconus is a progressive eye disorder that causes the cornea to thin and bulge into a cone-like shape, leading to distorted vision. The exact underlying cause of keratoconus is not yet fully understood, but there are several possible etiologies that have been proposed. Some of these include:

  1. Genetic factors: Keratoconus appears to have a strong genetic component, as it tends to run in families. Studies have identified several genes that may be involved in the development of keratoconus.
  2. Environmental factors: Certain environmental factors may contribute to the development of keratoconus, including chronic eye rubbing, exposure to UV light. Other factors that have been associated with keratoconus include atopy (a predisposition to allergic reactions),Down syndrome, and connective tissue disorders.
  3. Hormonal imbalances: Some studies have suggested that hormonal imbalances may play a role in the development of keratoconus. For example, there is some evidence to suggest that changes in estrogen levels during puberty and pregnancy may contribute to the onset of the disease.
  4. Enzymatic imbalance: It has been proposed that an imbalance of enzymes such as matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) could play a role in the development of keratoconus.
  5. Oxidative stress: Some studies have suggested that oxidative stress may contribute to the development of keratoconus.
  6. Inflammatory processes: Inflammation may also play a role in the development of keratoconus. For example, some studies have suggested that the presence of pro-inflammatory cytokines in the cornea may contribute to the thinning and weakening of the corneal tissue.

It is likely that keratoconus results from a combination of these and other factors, and more research is needed to fully understand the underlying etiologies of the disease, but it is believed to be caused by a combination of genetic and environmental factors.

While the exact cause of keratoconus is not known, early diagnosis and treatment can help slow the progression of the disease and improve vision.

Risk factors for progression of keratoconus

The progression of keratoconus can vary from person to person, but there are several risk factors that have been identified as potentially increasing the likelihood of more rapid disease progression. These include:

  1. Young age at diagnosis: Keratoconus typically develops in the teenage years or early 20s, and those who are diagnosed at a younger age may be at a higher risk for more rapid progression.
  2. Family history: Keratoconus has been found to have a genetic component, and those with a family history of the condition may be at a higher risk for more rapid progression.
  3. Eye rubbing: Frequent eye rubbing, especially if it is vigorous, can cause mechanical stress on the cornea and potentially accelerate the progression of keratoconus.
  4. Allergies: Patients with allergies, especially those with allergic eye disease, may be at a higher risk for more rapid progression of keratoconus.
  5. Contact lens wear: Long-term and improper use of contact lenses, especially rigid gas permeable lenses, may potentially worsen keratoconus.
  6. Thin corneas: Those with thinner corneas may be at a higher risk for more rapid progression of keratoconus.
  7. Hormonal changes: Some studies have suggested that hormonal changes, such as those during pregnancy, may exacerbate keratoconus.

It is important for those with keratoconus to have regular eye exams and monitor any changes in their vision or symptoms. Treatment can help slow or stabilize the progression of keratoconus, and early intervention is key to achieving the best outcomes.

How do you prevent keratoconus progression?

There are several ways to prevent or slow down the progression of the keratoconus. These include:

  1. Regular eye exams: It is important to have regular eye exams with an eye doctor who is experienced in the management of keratoconus. This can help monitor the progression of the disease and detect any changes early on.
  2. Avoiding eye rubbing: Vigorous eye rubbing can put mechanical stress on the cornea and potentially accelerate the progression of keratoconus. It is important to avoid rubbing the eyes or to do so gently.
  3. Treating allergies: Patients with allergies, especially those with allergic eye disease, should have their symptoms managed by an allergist or an ophthalmologist to reduce the risk of progression of keratoconus.
  4. Proper contact lens wear: Patients with keratoconus who wear contact lenses should use soft contact lenses or specialized contact lenses designed for keratoconus. It is also important to follow proper hygiene and wear schedules to avoid further damage to the cornea.
  5. Corneal cross-linking: Corneal cross-linking is a minimally invasive procedure that uses ultraviolet light and riboflavin drops to strengthen the cornea and slow down the progression of keratoconus.
  6. Intrastromal corneal ring segments (ICRS): ICRS are small plastic inserts that are surgically implanted into the cornea to help reshape it and improve vision.
  7. Corneal transplant: In advanced cases of keratoconus, a corneal transplant may be necessary to replace the damaged cornea with a healthy donor cornea.

It is important to note that the management of keratoconus is individualized and depends on the severity of the disease and the patient's specific needs. Patients should discuss their treatment options with an experienced eye care professional to determine the best course of action for their particular case.

How to prevent keratoconus progression with crosslink treatment?

Corneal cross-linking is a procedure that can help prevent the progression of keratoconus by strengthening the cornea. During the procedure, a photosensitizing agent (riboflavin) is applied to the cornea, and then ultraviolet light is used to activate the agent and create new cross-links between the collagen fibers in the cornea. These cross-links help to stabilize the cornea and prevent further thinning and bulging.

To prevent progression with crosslink treatment, it is important to follow the postoperative instructions provided by your ophthalmologist. These may include using antibiotic and anti-inflammatory eye drops to prevent infection and reduce inflammation, avoiding rubbing or touching the eye, and wearing a protective shield over the eye while sleeping.

It is also important to attend follow-up appointments with your eye care professional to monitor the progress of the treatment and ensure that the cornea is healing properly. Your eye care professional may recommend additional treatments or adjustments to your contact lens prescription to optimize your visual acuity.

While cross-linking can help to prevent the progression of keratoconus, it is important to note that the procedure may not reverse any existing damage or improve vision. Patients with keratoconus should discuss their treatment options with an experienced ophthalmologist to determine the best course of action for their particular case.

How to treat keratoconus? What are the options for therapy?

Keratoconus is a progressive eye disease characterized by a thinning and bulging of the cornea, which leads to distorted vision and, in some cases, significant visual impairment.While there is no cure for keratoconus, there are several treatment options available that can help to manage the condition and improve vision slow or halt the progression of the disease, including corneal cross-linking therapy, contact lenses, and corneal transplant.

Corneal cross-linking

Corneal cross-linking (CXL) is a minimally invasive procedure that involves the use of ultraviolet light and a photosensitizing agent called riboflavin to strengthen the cornea and prevent further thinning and bulging. The procedure works by creating new cross-links between the collagen fibers in the cornea, which helps to stabilize the cornea and improve its structural integrity.

Corneal cross-linking typically takes about an hour to complete and is performed under topical anesthesia in an outpatient setting. The first step involves the removal of the epithelial layer of the cornea, which allows the riboflavin drops to penetrate into the deeper layers of the cornea. The drops are then applied to the cornea every few minutes for about 30 minutes, during which time the cornea is exposed to ultraviolet light to activate the photosensitizer and create the new cross-links. Finally, a bandage contact lens is placed over the eye to protect the cornea while it heals.

Corneal cross-linking is considered a safe and effective treatment option for keratoconus, with studies showing that it can slow or halt the progression of the disease in the majority of cases. In addition to stabilizing the cornea, CXL has also been shown to improve visual acuity and reduce irregular astigmatism in many patients.However, corneal cross-linking is most effective when performed in the early stages of keratoconus, before the cornea becomes too severely distorted.

The long-term outcomes of CXL appear to be favorable, with studies showing that the procedure can maintain corneal stability and prevent further deterioration for up to 10 years or more. However, it is important to note that CXL is not a cure for keratoconus and may not improve existing vision problems.

In addition to slowing or halting the progression of keratoconus, CXL may also be beneficial for patients who are considering other types of corneal surgery, such as corneal transplant. By stabilizing the cornea, CXL may improve the outcomes of these procedures and reduce the risk of complications.

While CXL is generally considered safe, there are some risks associated with the procedure, including corneal haze, infection, and delayed healing. It is important to discuss the risks and benefits of CXL with your ophthalmologist to determine if the procedure is right for you.

Croslinking in children with keratoconus

Corneal cross-linking (CXL) is a treatment option for children with keratoconus.  Studies have shown that CXL is safe and effective for that indication.It may be an effective way to slow or halt the progression of the disease. Here are a few key points about CXL in children with keratoconus:

  1. Age: CXL can be performed on children as young as 8 years old, although the exact age at which it is appropriate may vary depending on the severity of the condition.
  2. Efficacy: CXL has been shown to be effective in halting the progression of keratoconus in children, and may improve visual acuity and reduce the need for more invasive surgical procedures.
  3. Safety: CXL is generally considered safe for children, with few serious side effects reported. However, as with any medical procedure, there are potential risks and complications, including infection, corneal haze, and vision loss.
  4. Procedure: CXL may be performed under general or local anesthesia depending upon the age of the child and takes about 30 to 60 minutes to complete.

Overall, CXL can be an effective treatment option for children with keratoconus, and may help to prevent the need for more invasive surgical procedures in the future. If you are considering CXL for your child, it is important to discuss the potential risks and benefits with the ophthalmologist to determine if this is the right treatment option.

Contact Lenses

Contact lenses are a common treatment option for managing keratoconus, as they can help to improve vision and provide a more comfortable and stable fit for the irregularly shaped cornea. There are several types of contact lenses that may be used to manage keratoconus, including soft contact lenses, rigid gas permeable (RGP) lenses, and scleral lenses.

Soft contact lenses are typically used in the early stages of keratoconus when the corneal shape is only slightly distorted. These lenses are made of soft, flexible materials that can conform to the shape of the cornea and provide a more comfortable fit than rigid lenses. However, they may not be effective at correcting more advanced stages of the condition.

Rigid gas permeable (RGP) lenses are another option for managing keratoconus, particularly in the later stages of the condition when the cornea is more severely distorted. These lenses are made of rigid, gas-permeable materials that can provide a more stable fit and sharper vision than soft lenses. However, they may be less comfortable to wear than soft lenses and may require a longer adjustment period.

Scleral lenses are a newer type of contact lens that may be used to manage more advanced stages of keratoconus. These lenses are larger than traditional contact lenses and are designed to vault over the cornea and rest on the white part of the eye (the sclera). This can help to provide a more stable fit and better vision correction for severely distorted corneas. Scleral lenses may also be more comfortable to wear than RGP lenses.

Corneal transplant

Corneal transplant, also known as corneal grafting, is a surgical treatment option for patients with advanced keratoconus who have significant corneal thinning or scarring that cannot be managed by other treatments such as contact lenses, eyeglasses or intracorneal rings.

During the procedure, the surgeon removes the damaged or diseased cornea and replaces it with a donor cornea that has been carefully selected and prepared. The new cornea is then stitched into place and allowed to heal.The donor cornea is usually obtained from a deceased individual who has donated their eyes for transplantation.

Corneal transplant is a complex surgical procedure that requires skill and experience. The procedure can be performed under local or general anesthesia and typically takes around one to two hours to complete. The patient may need to stay in the hospital for a short period after the procedure to monitor for complications.

After the surgery, patients will need to use eye drops and take other medications as prescribed to prevent infection, reduce inflammation and promote healing. It is also important to follow the post-operative care instructions provided by the surgeon to ensure the best possible outcome.

Corneal transplant can provide significant benefits for patients with advanced keratoconus, including improved vision and reduced symptoms such as glare, halos and double vision. However, like any surgical procedure, corneal transplant carries some risks and potential complications, including infection, rejection of the donor tissue, and other vision problems.

It is important to discuss the potential benefits and risks of corneal transplant with an experienced eye surgeon before making a decision. The surgeon will evaluate the patient's individual situation and determine if corneal transplant is the most appropriate treatment option for them.

DALK surgery in keratoconus

Deep anterior lamellar keratoplasty (DALK) is a surgical treatment option for patients with keratoconus who have corneal thinning but still have a relatively healthy inner layer of the cornea. It is an alternative to traditional corneal transplantation, which replaces the entire cornea, including the inner layer.

During DALK surgery, the surgeon removes the outer layers of the cornea, leaving the healthy inner layer intact. A donor cornea is then transplanted onto the remaining healthy tissue. The donor cornea is carefully selected to match the shape and curvature of the patient's cornea.

The advantage of DALK over traditional corneal transplantation is that it preserves the inner layer of the cornea, which reduces the risk of complications such as graft rejection and infection. Additionally, DALK can provide better visual outcomes and a faster recovery time compared to traditional corneal transplantation.

DALK surgery is performed under local or general anesthesia and takes about one to two hours to complete. The patient may need to stay in the hospital for a short period after the procedure to monitor for complications. After the surgery, patients will need to use eye drops and take other medications as prescribed to prevent infection, reduce inflammation and promote healing.

DALK surgery can provide significant benefits for patients with keratoconus, including improved vision and reduced symptoms such as glare, halos and double vision. However, like any surgical procedure, DALK carries some risks and potential complications, including infection, rejection of the donor tissue, and other vision problems.

It is important to discuss the potential benefits and risks of DALK surgery with an experienced eye surgeon before making a decision. The surgeon will evaluate the patient's individual situation and determine if DALK is the most appropriate treatment option for them.

Keratoconus intracorneal ring treatment

Intracorneal ring segments (ICRS) are a type of surgical treatment for keratoconus that can help to improve vision and reduce symptoms of the condition. During the procedure, small, clear plastic or acrylic rings are implanted into the cornea to reshape it and reduce its irregularity.

ICRS can be a good option for patients with moderate to advanced keratoconus who are not candidates for other treatments, such as corneal cross-linking or contact lenses. The procedure is typically performed on an outpatient basis and can be completed in about 30 minutes.

Before the procedure, the patient's cornea is measured using special imaging technology to determine the size and position of the ICRS. The surgeon then creates small incisions in the cornea and inserts the rings into the appropriate location. Once in place, the rings help to reshape the cornea and reduce its curvature, improving vision and reducing astigmatism.

ICRS can provide significant benefits for patients with keratoconus, including improved vision, reduced dependence on glasses or contact lenses, and decreased symptoms such as glare and halos. The procedure is generally safe and well-tolerated, with most patients experiencing only mild discomfort or sensitivity following the treatment.

However, like any surgical procedure, ICRS does carry some risks and potential complications. These can include infection, inflammation, or rejection of the implants. In addition, the rings may need to be adjusted or removed in some cases, particularly if the patient experiences discomfort or other issues following the procedure.

Overall, ICRS can be an effective treatment option for patients with keratoconus, particularly in cases where other treatments are not effective or suitable. However, it is important to discuss the potential benefits and risks of the procedure with an experienced eye surgeon before making a decision.

Keratoconus treatment with combined croslinking and laser

In some cases, corneal cross-linking (CXL) alone may not be enough to fully stabilize the cornea or improve vision. In these situations, a combination treatment of CXL and laser therapy may be recommended.

The combination treatment may involveperforming CXL first, followed by laser therapy several months later or performing CXL and laser at the same time.  The laser therapy used in combination with CXL is typically either photorefractive keratectomy (PRK) or topography-guided custom ablation treatment (T-CAT). PRK involves removing a thin layer of the cornea using a laser, which can help to improve vision and reduce the irregular shape of the cornea. T-CAT is a more precise type of laser treatment that uses advanced imaging technology to map the shape of the cornea and guide the laser in reshaping it.

The timing and type of laser therapy used in combination with CXL will depend on the individual patient's needs and the extent of their keratoconus. It is important to discuss the potential benefits and risks of combination treatment with an experienced eye surgeon before making a decision. The surgeon will evaluate the patient's individual situation and determine if combination treatment is the most appropriate treatment option for them.

Combining laser therapy with CXL can provide significant benefits for patients with keratoconus, including improved visual acuity and reduced dependence on contact lenses or glasses. The combination treatment can also help to prevent further progression of the disease, reducing the risk of more invasive treatments being necessary in the future. However, it is important to note that the results of combination treatment may vary from patient to patient, and there is always a risk of complications associated with any surgical procedure. Patients should carefully consider the potential benefits and risks of combination treatment and discuss their options with an experienced eye surgeon before making a decision.

Phakic intraocular lens implantation in keratoconus

Phakic intraocular lenses (IOLs) are artificial lenses that are surgically implanted into the eye to correct refractive errors such as nearsightedness, farsightedness, or astigmatism.

In cases of keratoconus, phakic IOL surgery may be indicated if the patient has a high degree of refractive error and contact lenses or glasses are not sufficient to correct it. The surgery involves implanting the phakic IOL between the iris and natural lens of the eye, which can help to improve vision and reduce the need for corrective lenses.

Studies have shown that phakic IOL surgery can be effective in improving vision in patients with keratoconus. However, it is important to note that not all patients with keratoconus are good candidates for phakic IOL surgery. The decision to undergo surgery should be made on a case-by-case basis, taking into account the individual patient's needs and overall eye health.

As with any surgical procedure, there are risks associated with phakic IOL surgeryincluding infection, inflammation, and damage to the cornea or other structures in the eye. Patients considering this procedure should discuss the potential risks and benefits with their eye surgeon.

Cataract surgery in Keratoconus Patients

Patients with keratoconus may also develop cataracts, which can further affect their vision. In these cases, cataract surgery may be indicated to remove the cloudy lens and improve vision.

However, cataract surgery in patients with keratoconus can be more complex than in patients without this condition, due to the irregular shape of the cornea. Specialized techniques, such as the use of toric intraocular lenses and femtosecond laser technology, may be used.  In addition, patients with keratoconus may require additional procedures, such as corneal cross-linking, before or after cataract surgery to stabilize the cornea and prevent further progression of the condition.

The success of cataract surgery in patients with keratoconus depends on a variety of factors including the severity of the keratoconus, the presence of other eye conditions, and the overall health of the eye. Patients considering cataract surgery should discuss the potential risks and benefits with their eye surgeon.

Keratoconus care with Professor Yonca Akova

Professor Akova diagnoses keratoconus using advanced technology including corneal topography and tomography, corneal OCT and other tests.  Dr Akova  has also extensive expertise in treating keratoconus including gas permeable and scleral contact lenses, corneal crosslinking, combined treatments with laser and corneal transplants as well as phakic intraocular lenses and cataract surgery in keratoconus.  Choice of treatment depends on the progression of your keratoconus condition. Dr. Akova also has broad experience in the management of children with corneal diseases and keratoconus including treatment with corneal crosslinking.

Update Date: 28.03.2023
Professor Yonca Aydın Akova, M.D. FEBO
Editor
Professor Yonca Aydın Akova
Ophthalmologist and Eye Surgeon
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