Adriana C. Lotfi, MD

Keratoconus is a noninflammatory, progressive, bilateral ectatic corneal disease with corneal stromal thinning that results in weakening and surface distortion of the cornea. The onset of this disease process is often between the ages of 10 and 25 years. Blurred vision is usually secondary to irregular astigmatism, myopia and corneal scarring. The ectatic cornea often takes the shape of a cone. Risk factors for keratoconus include a family history of keratoconus, excessive eye rubbing, atopic disorder, obstructive sleep apnea, connective tissue afflictions such as Marfan syndrome, osteogenesis imperfecta, Ehlers-Danlos syndrome, and other conditions such as Down syndrome, floppy eyelid syndrome, aniridia, Leber’s congenital amaurosis and retinopathy of prematurity.

Corneal transplantation has progressed significantly from full-thickness penetrating keratoplasty to selective corneal transplantation in which only the diseased portions of corneal tissue are replaced surgically with similar healthy donor tissue. This has revolutionized corneal transplantation because the healthy parts of the patient’s cornea are retained. When the endothelium is untouched surgically, this eliminates the possibility of endothelial graft rejection. The diseased portion of the cornea needs to be localized to the anterior regions of the patient’s cornea, such as in keratoconus, while the endothelium remains healthy.

Most ophthalmologists would probably agree that the treatment of keratoconus has come a long way in recent years.

La mayoría de los oftalmólogos probablemente estaría de acuerdo en que el tratamiento de los queratoconos ha avanzado mucho en los años recientes.

A maioria dos oftalmologistas provavelmente concordaria que o tratamento de ceratocone já avançou bastante nos últimos anos.

Keratoconus treatment options have recently expanded from spectacles, contact lenses and full-thickness penetrating keratoplasty to collagen cross-linking, intracorneal ring segments, phakic IOLs, toric IOLs, wavefront topography-guided photoablative procedures, and deep and total anterior lamellar keratoplasty procedures with retention of the patient’s healthy corneal endothelium to prevent endothelial graft rejection. When a keratoconus patient is no longer able to wear a contact lens for functional vision, surgical intervention may be considered. The various treatment options need to be discussed with the patient. The choice of treatment will depend on the individual case, the extent of keratoconus and whether any previous surgical procedures have been performed.