Keratoconus: A New Perspective in the Advanced Treatment of Corneal Dystrophy

About Keratoconus
Keratoconus represents a distinct challenge in the field of ophthalmology, being classified as a non-inflammatory corneal dystrophy. This condition is often linked to a genetic predisposition, with a probability of inheritance of about 10%, and is manifested by changes in corneal shape. Associations with systemic conditions such as Down syndrome, Turner syndrome, Marfan syndrome, atopy, osteogenesis imperfecta and mitral valve prolapse, as well as with other ocular disorders, emphasize the complexity and diversity of keratoconus presentation. The Manifestation of Keratoconus: Symptoms and Early Signs
Adolescence is the typical period of manifestation of keratoconus, which affects one or both eyes. Patients report a decrease in visual acuity, contact lens intolerance and the development of irregular astigmatism. The conical appearance of the cornea becomes a hallmark. Keratotopography remains the most sensitive diagnostic method, revealing early signs. Progression and Treatment of Keratoconus
As the condition progresses, there is a decrease in visual acuity, Munson’s symptom (protrusion of the lower eyelid when looking down) and iron deposition in the epithelium, forming the Fleischer ring surrounding the cone. In advanced stages, stromal scarring occurs and rupture of the Descemet’s membrane can lead to corneal edema. There are three morphologic types of keratoconus: spheroidal, oval, and conical, each with distinct characteristics and diagnostic challenges. Based on severity, keratoconus is categorized into stages from initial to severe:
Incipient form – corneal refraction is less than 48 diopters
intermediate form – between 48-54 diopters
Severe form – over 54 diopters Innovations in Treatment: From Lenses to Surgical Interventions
Treatment of keratoconus has evolved from the use of gas-permeable lenses with scleral fixation to innovative surgical procedures. “Collagen crosslinking, which strengthens the corneal collagen matrix using an excimer laser and riboflavin solution, has shown positive results. In early cases, the use of lenses and the implantation of intrastromal corneal segments may have beneficial
effects. For advanced cases, with risk of perforation and significant loss of vision, perforator keratoplasty becomes a necessary option (corneal transplantation)