Treatment of early keratoconus
Pediatric Eye Clinic
Treatment of early keratoconus includes the use of glasses or soft contact lenses to improve visual acuity. When irregular astigmatism precludes adequate correction with glasses or soft lenses, rigid gas-permeable contact lenses, which mask the surface irregularities, often restore vision. Some patients, however, cannot be comfortably fit with a rigid lens, and as the disease progresses, the cornea may become too steep to maintain a contact lens on the eye. In some cases, this can be managed with the use of newer, ultra-large scleral, rigid gas-permeable contact lenses, but cost and need to travel to be fit with these lenses can be prohibitive. In addition, central corneal scarring can limit vision despite the use of any optical device. Traditionally, when patients could not get adequate vision with either glasses or contact lenses, the only surgical option has been penetrating keratoplasty (PKP).
Recent advances have added to the surgical options for keratoconus. They also can be applied to two closely related diseases, pellucid marginal degeneration and post-LASIK ectasia. Intracorneal ring segments can improve uncorrected (UCVA) and best-corrected visual acuity (BCVA), or allow for successful contact lens fitting in a previously unfittable patient, avoiding the need for keratoplasty. A new technique called collagen crosslinking (CXL) can increase the biomechanical rigidity of the cornea, flatten the cornea, and prevent progression of the disease. While laser remodeling of the cornea would threaten to worsen the disease in an untreated cornea, it might be successfully and safely performed in a crosslinked cornea.
Source: aao
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Pediatric Eye Clinic.
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