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Keratoconus

Progressive thinning of the cornea. 

An evenly shaped cornea is an important component of our eye.
Together with the eye lens it forms the optical system in other words the camera lens of our eye. There are several types of corneal diseases that can strongly compromise our vision.

If in the case of a structural weakness the cornea shows an irregular protrusion and a thinning, this can be a sign of a hidden disease such as keratoconus. Symptoms are oscillations and continuous decrease of vision in spite of glasses or contact lenses.

Why do I suffer from keratoconus?

The word is composed of the Greek expression Keratos for “horn” and conus for “conical”. In the human population Keratoconus is found in at least 1:2000. Although the first cornea transplantation has been carried out already in 1888, still today in spite of extensive studies the causes for keratoconus are not completely known.

Genetic causes are a probability; a divergence of the biochemical structure of the cornea has also been observed.

What are the symptoms of a keratoconus?

Keratoconus leads to an increased protrusion of the cornea. Since the cornea is an important component of the eye´s optic this protrusion leads to a series of different symptoms: oscillations of visual acuity in spite of glasses or contact lenses, the appearance of halos around light fonts (halos or ghost images) and a major sensibility to light and dazzle.  

Every second patient suffers more or less from some kind of hyper-sensitivity such as e.g. dry eyes, strong sensitivity to light or general diseases such as skin problems, soft-tissue rheumatism, allergies, and asthma or thyroid insufficiency.

How to prevent keratoconus?

It is not possible to actively prevent keratoconus as far as current knowledge shows. With high probability a genetic disposition is an additional cause for the disease.

It makes sense though, not to strain the eye and the cornea by strongly rubbing the eye. Rooms with dusty and smoky air should possibly be avoided.

The different types of keratoconus

We distinguish between a „ still“ type of keratoconus the so-called „Forme Fruste“ and the „progressive“ type.

The “Forme Fruste” is ten times more common than the progressive type and normally shows no symptom. The patient cannot distinguish between “FormeFruste” and corneal curvature which can be corrected with glasses or contact lenses. “FormeFruste” is detected frequently during an ophthalmological examination and only needs medical supervision; in a stable condition it does not necessitate therapy.

The progressive type can have an impact already in the early teens. As the disease proceeds, it gets harder to correct the eye-sight with glasses due to the irregular protrusion of the cornea. Contact lenses are a better way since they apply pressure to the cornea therefore compensating the main irregularities.

In most of the disease´s stages the patient can rely on a visual acuity up to 100%. With the continuing increase of the corneal protrusion at a certain point it is no longer possible to wear contact lenses. Because of the increasing protrusion the cornea below its central hub gets thinner and thinner, it can break and scar; in the long run this weakens the eye-sight. 

Up to now the only possible therapy was a transplantation of the cornea; this is organ transplantation and therefore surgery which involves risks and complications. Adequate vision often is reached only after one to two years.  Moreover it is mostly young people that have to undergo corneal transplantation with keratoconus who have to cope with the transplanted cornea for many decades; this implies that the transplant has to function perfectly for years.

A simple and low-risk therapy is the stabilisation with CXL, the so-called Cornea Cross Linking. A successful treatment leads to a reduction of growth of the protrusion and the thinning of the cornea and thus to the avoidance of a transplantation of the cornea.

Another method for the treatment of keratoconus and the avoidance of transplantation is the insertion of intracorneal ring segments (ICRS) for the stabilisation of the cornea.  

Treatment of keratoconus with CXL

Cornea Crosslinking is a method for mechanical stabilisation of tissue. In other medical fields such as orthopaedics, otorhinolaryngology, and cardiac surgery it has been applied for many years.

Crosslinking of the cornea is achieved by the combination of UV irradiation in combination with riboflavin eye drops (a derivate of vitamin B2). This leads to an increased number of cross-links between the parallel corneal fibres.  It is like a net that with additional struts gains mechanical stability. The energy level of UV rays is such that is does not affect the eye-structure under the cornea. 

It is an out-patient surgery of about 45 minutes with local anaesthesia. In a first step the superficial cell layer, the epithelium, is removed so that the riboflavin (Vitamin B2) can penetrate the cornea. Once the cornea is saturated with the riboflavin, it is irradiated for 10 minutes with UV light. The UV radiation of the riboflavin leads to a new cross-linking and a reinforcement of the corneal fibres. After the laser treatment an ointment contact lens is placed into the eye for 3-4 days until the corneal epithelium has healed naturally.

To improve the unevenness of the cornea the CXL method can be combined either with the implantation of ICRS or a superficial laser treatment (LASEK/PRK).   

To strengthen the cornea and to improve the visual acuity after approximately 4 weeks a rigid contact lens can be fitted.

Treatment of keratoconus with ICRS

ICRS, intracorneal ring segments, are a unique option to improve the visual acuity and in most cases postpone a transplantation of the cornea. This method was developed for patients in need of a correction of short-sightedness as well as of astigmatism (corneal curvature) with keratoconus when contact lenses or glasses do not offer any possibility of improvement.

The intracorneal ring segments are semi-circular Plexiglas rings which are introduced into the corneal tissue (stroma). In a first step the Femtoseconds laser in a gentle and precise way forms a pocket into which one or two synthetic half-rings are introduced. The patented design of the ICRS remodels the architecture of the cornea to restore its natural form.

Aim of this procedure is to improve the vision capacity of keratoconus patients with the help of glasses or contact lenses. In the few cases of ICRS patients where satisfactory vision improvement could not be achieved a later corneal transplant surgery was carried out without additional complications.

Both treatments are out-patient treatments. For optimal results these methods – (CCL and ICRS) can be combined so that not only a stiffening of the cornea but also an improvement of sight can be achieved.

The Smile Eyes plus in safety

  • Extensive preliminary examination and consultation exclusively by experiences ophthalmologists 
  • Modern surgery units with up-to-date certified hygienic standards
  • State of the art laser technology 
  • Highly qualified surgeons with year-long experience
  • Regular aftercare
  • Fair price management
  • Quality management according to ISO 9001
Any questions regarding treatment possibilities of keratoconus?
Please call us:
+49 800 855 8000

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