Often appearing in the teens or early twenties, keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape.
This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes.
Keratoconus can be difficult to detect, because it usually develops so slowly. However, in some cases, it may proceed rapidly. As the cornea becomes more irregular in shape, it causes progressive nearsightedness and irregular astigmatism to develop, creating additional problems with distorted and blurred vision. Glare and light sensitivity also may be noticed. Keratoconic patients often have prescription changes every time they visit their eye care practitioner. It’s not unusual to have a delayed diagnosis of keratoconus, if the practitioner is not familiar with the early-stage symptoms of the disease.
New research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family. Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fit contact lenses and chronic eye irritation.
In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses or soft contacts no longer provide adequate vision correction. The Pentacam, a rotating Scheimpflug camera which captures Scheimpflug images of the anterior eye segment is commonly used for early diagnosis of Keratoconus.
Corneal Cross Linking: Another new procedure for treating keratoconus, known by the brand name of C3-R (corneal collagen cross-linking with riboflavin), is a non-invasive method of strengthening corneal tissue to halt bulging of the eye’s surface.
In the C3-R procedure, eye drops containing riboflavin (vitamin B2) are placed on the cornea and are then activated by ultraviolet (UV) light to strengthen links between the connective tissue (collagen) fibers within the cornea.
Corneal transplant: Some people with keratoconus can’t tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision. The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK or PKP). Even after a transplant, you most likely will need glasses or contact lenses for clear vision.
Since the Keratoconus will cause corneal irregular shape which is manifested by irregular corneal astigmatism that causes deformation of the image. A modification of the irregular shape of cornea can be achieved by means of topography guided laser (T-CAT) photorefractive keratectomy as a first step of treatment and this amazing technique will improve the quality of vision and eventually the visual acuity and even we can reach the point of freedom of glasses, then at the same sessions to maintain and fix the new cornea regular shape that we achieved by laser (T-CAT PRK).
We will perform collagen cross linking procedure to increase the stiffness of the cornea, stabilize and stop the conic process. The Name of this new Technique is simultaneous T-CAT PRK with CXL that will provide the following: 1. Correct the corneal irregular shape, 2. Improve the quality of vision, 3. Improve the visual Acuity, 4. Stabilizes the cornea and protect the patient from the need of Keratoplasty.