Keratoconus management shifts from replacing to remodeling the cornea

Theo Seiler

PARIS — The last decade has witnessed a definite paradigm shift in the management of keratoconus, according to a surgeon here.

"We are now thinking in terms of remodeling the cornea rather than replacing it as it was until a few years ago," Theo Seiler, MD, said at the meeting of the European Society of Cataract and Refractive Surgeons here.

Even replacement, when eventually necessary, has changed, he said.

"We now perform DALK and only the stroma is removed, minimizing rejection and astigmatism induction," he said.

However, though far less invasive than PK, DALK is a time consuming operation, lasting 1 hour or more. It is also a difficult procedure, still leading to a 20% conversion rate due to perforation, he said.

Support elements, like intracorneal rings, are already a step toward remodeling because they flatten the cone.

"They are simple and fast to implant, but still have a 10% complication rate and failure occurs in 20% to 30% of the cases," Dr. Seiler noted.

Collagen cross-linking is a crucial step toward achieving corneal remodeling.

"It is simple and fast, has a low, 1% complication rate and only fails in 3% of the cases. The drawback at this stage is that it needs additional visual rehabilitation," he said.