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Management of Keratoconus

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Quick Guide to the Management of Keratoconus

Abstract

Management of KC has advanced during the last few years and still in progress. As there are new modalities of treatment, it is better to say that there are traditional modalities and modern modalities of treatment rather than saying old and new. That is because the old modalities such as spectacle correction, contact lenses, penetrating keratoplasty (PKP), and conductive keratoplasty is still used although the demand upon the last two modalities has been decreased by the modern alternatives. In this chapter, there will be a high concentration on the main two modern modalities of treatment: the intracorneal rings (ICRs) and the corneal collagen cross-linking (CxL). These treatment modalities are relatively new and caution should be taken when taking the decision to use them and the surgeon should be aware of their indications, contraindications, conditions, and complications, hence the aim of this book.

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Bibliography

  • Aguilar-Valenzuela L et al (2003) Intraocular pressure in myopic patients after Worst-Fechner anterior chamber phakic intraocular lens implantation. J Refract Surg 19(2):131–136

    PubMed  Google Scholar 

  • Alessandro M et al (2005) Conservative treatment of early an moderate pellucid marginal degeneration: a new refractive approach with intracorneal rings. Ophthalmology 112:660–666

    Article  Google Scholar 

  • Alfonso FJ et al (2011) Intrastromal corneal ring segments and posterior chamber phakic intraocular lens implantation for keratoconus correction. J Cataract Refract Surg 37:706–713

    Article  PubMed  Google Scholar 

  • Alio JL, Azar DT (2008) Management of complications in refractive surgery. Springer, Heidelberg

    Book  Google Scholar 

  • Alio JL, De La Hoz F and Ismail MM (1993). Subclinical inflammatory reaction induced by phakic anterior chamber lenses for the correction of high myopia: ocular lenses for the correction of high myopia. Avaliable at http://www.tandf.co.uk/swets.asp. In: Ocular immunology and inflammation, Vol 1. Swets & Zeitlinger 219–223.

  • Alio JL et al (1999) Phakic anterior chamber lenses for the correction o myopia: a 7-year cumulative analysis of complications in 26 cases. Ophthalmology 106(3):458–466

    Article  PubMed  CAS  Google Scholar 

  • Alio JL et al (2006a) Analysis of results related to good and bad outcomes of intacs implantation for keratoconus correction. J Cataract Refract Surg 32:756–761

    Article  PubMed  Google Scholar 

  • Alio JL et al (2006b) Intracorneal ring segments for keratoconus correction: long-term follow-up. J Cataract Refract Surg 32:978–985

    Article  PubMed  Google Scholar 

  • Allemann N et al (2000) Myopic angle-supported intraocular lenses: two-year follow-up. Ophthalmology 107(8):1549–1554

    Article  PubMed  CAS  Google Scholar 

  • Ardjomand N et al (2002) Pupillary block after phakic anterior chamber intraocular lens implantation. J Cataract Refract Surg 28(6):1080–1081

    Article  PubMed  Google Scholar 

  • Arne JL, Lesueur LC (2000) Phakic posterior chamber lenses for high myopia: functional and anatomical outcomes. J Cataract Refract Surg 26(3):369–374

    Article  PubMed  CAS  Google Scholar 

  • Arriola-Villalobos P (2009) Intrastromal corneal ring segment implantation for high astigmatism after penetrating keratoplasty. J Cataract Refract Surg 35:1878–1884

    Article  PubMed  Google Scholar 

  • Asano-Kato N et al (2005) Experience with the Artisan phakic intraocular lens in Asian eyes. J Cataract Refract Surg 31(5):910–915

    Article  PubMed  Google Scholar 

  • Assetto V et al (1996) Collamer intraocular contact lens to correct high myopia. J Cataract Refract Surg 22(5):551–556

    PubMed  CAS  Google Scholar 

  • Assil KK (2008). The ARTISAN myopia lens: interim results of the US FDA clinical study. Available at http://emedicine.medscape.com/article/1221908-overview. Accessed Dec 2008.

  • Benedetti S et al (2005) Correction of myopia of 7 to 24 diopters with the Artisan phakic intraocular lens: two-year follow-up. J Refract Surg 21(2):116–126

    PubMed  Google Scholar 

  • Caroline P et al. (2006). Etiology, diagnosis, and management of keratoconus: new thoughts and new understandings. Pacific University College of Optometry. Retrieved on 26 March 2006.

    Google Scholar 

  • Colin J (2006) European clinical evaluation: use of intacs for the treatment of keratoconus. J Cataract Refract Surg 32:747–755

    Article  PubMed  Google Scholar 

  • Colin J, Velou S (2003) Current surgical options for keratoconus. J Cataract Refract Surg 29:379–386

    Article  PubMed  Google Scholar 

  • Colin CK et al (2007) Effect of inferior-segment intacs with and without C3-R on keratoconus. J Cataract Refract Surg 33:75–80

    Article  Google Scholar 

  • Consuelo F et al (2010) Causes of intrastromal corneal ring segment explantation: clinicopathologic correlation analysis. J Cataract Refract Surg 36:970–977

    Article  Google Scholar 

  • Coskunseven E et al (2009) Effect of treatment sequence in combined intrastromal corneal rings and corneal collagen crosslinking for keratoconus. J Cataract Refract Surg 35(12):2084–2091

    Article  PubMed  Google Scholar 

  • Dejaco-Ruhswurm I et al (2002) Long-term endothelial changes in phakic eyes with posterior chamber intraocular lenses. J Cataract Refract Surg 28(9):1589–1593

    Article  PubMed  Google Scholar 

  • Ertan A (2009) Early and severe keratoconus treatment options: do intacs intracorneal rings ensure optimal outcomes? Ophthalmol Times Eur 5(2): 2–4

    Google Scholar 

  • Ertan A, Bahadir MJ (2006) Intrastromal ring segment inser­tion using a femtosecondlaser to correct pellucid marginal ­corneal degeneration. J Cataract Refract Surg 32(10):1710–1716

    Article  PubMed  Google Scholar 

  • Ertan A, Colin J (2007) Intracorneal rings for keratoconus and keratectasia. J Cataract Refract Surg 33:1303–1314

    Article  PubMed  Google Scholar 

  • Espandar L, Meyer J (2010) Keratoconus: overview and update on treatment. Middle East Afr J Ophthalmol 17(1):15–20

    PubMed  Google Scholar 

  • Fechner PU (1990) Intraocular lenses for the correction of myopia in phakic eyes: short-term success and long-term caution. Refract Corneal Surg 6(4):242–244

    PubMed  CAS  Google Scholar 

  • Fechner PU (1999) Cataract formation with a phakic IOL. J Cataract Refract Surg 25(4):461–462

    Article  PubMed  CAS  Google Scholar 

  • Fechner PU, Wichmann W (1993) Correction of myopia by implantation of minus optic (Worst iris claw) lenses into the anterior chamber of phakic eyes. Eur J Implant Refract Surg 5:55–59

    Google Scholar 

  • Fechner PU et al (1989) The correction of myopia by lens implantation into phakic eyes. Am J Ophthalmol 107(6):659–663

    PubMed  CAS  Google Scholar 

  • Fechner PU et al (1991) Correction of myopia by implantation of a concave Worst-iris claw lens into phakic eyes. Refract Corneal Surg 7(4):286–298

    PubMed  CAS  Google Scholar 

  • Fechner PU et al (1996) Posterior chamber myopia lenses in phakic eyes. J Cataract Refract Surg 22(2):178–182

    PubMed  CAS  Google Scholar 

  • Frederik Raiskup-Wolf et al (2008) Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cataract Refract Surg 34:796–801

    Article  Google Scholar 

  • Fyodorov SN et al (1993) Clinical and functional follow-up of minus IOL implantation in high grade myopia. Oftalmo­chirurgia 2:12–17

    Google Scholar 

  • Ghajarnia M et al (2008) Descemet detachment after femtosecond-laser-assisted placement of intrastromal ring segments in pellucid marginal degeneration. J Cataract Refract Surg 34(12):2174–2176

    Article  PubMed  Google Scholar 

  • Gonvers M et al (2001) Implantable contact lens for moderate to high myopia: short-term follow-up of 2 models. J Cataract Refract Surg 27(3):380–388

    Article  PubMed  CAS  Google Scholar 

  • Greenstein SA et al (2010) Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: Scheimpflug and biomicroscopic analysis. J Cataract Refract Surg 36:2105–2114

    Article  PubMed  Google Scholar 

  • Greenstein SA et al (2011) Corneal thickness changes after ­corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 37(4):691–700

    Article  PubMed  Google Scholar 

  • Grewal DS et al (2009) Corneal collagen crosslinking using riboflavin and ultraviolet-A light for keratoconus one-year analysis using Scheimpflu imaging. J Cataract Refract Surg 35:425–432

    Article  PubMed  Google Scholar 

  • He X et al (2010) Measurement of corneal changes after collagen crosslinking using a noninvasive ultrasound system. J Cataract Refract Surg 36(7):1207–1212

    Article  PubMed  Google Scholar 

  • Hersh PS et al (2011) Corneal collagen crosslinking for keratoconus and corneal ectasia: one-year results. J Cataract Refract Surg 37(1):149–160

    Article  PubMed  Google Scholar 

  • Jankov Ii MR et al (2010) Corneal collagen cross-linking. Middle East Afr J Ophthalmol 17(1):21–27

    PubMed  Google Scholar 

  • Javadi MA et al (2004) Lamellar crescentic resection for pellucid marginal corneal degeneration. J Refract Surg 20(2):162–165

    PubMed  Google Scholar 

  • Javadi MA et al (2005) Outcomes of penetrating keratoplasty in keratoconus. Cornea 24(8):941–946

    Article  PubMed  Google Scholar 

  • Jimenez-Alfaro I et al (2001) Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation. Ophthalmology 108(1):90–99

    Article  PubMed  CAS  Google Scholar 

  • Kamburoglu G et al (2007) Implantation of Artisan toric phakic intraocular lens following intacs in a patient with keratoconus. J Cataract Refract Surg 33:528–530

    Article  PubMed  Google Scholar 

  • Kashani AA (1996) Phakic posterior chamber intraocular lenses for the correction of high myopia. J Refract Surg 12(4):454–456

    PubMed  CAS  Google Scholar 

  • Kohlhaas M et al (2006) Biomechanical evidence of the distribution of cross-links in corneas treated with riboflavin and ultraviolet A light. J Cataract Refract Surg 2:279–283

    Article  Google Scholar 

  • Koller T et al (2009) Complication and failure rates after corneal crosslinking. J Cataract Refract Surg 35:1358–1362

    Article  PubMed  Google Scholar 

  • Kolli S, Aslanides IM (2010) Safety and efficacy of collagen crosslinking for the treatment of keratoconus. Expert Opin Drug Saf 9(6):949–957

    Article  PubMed  CAS  Google Scholar 

  • Krumeich JH, Duncker G (2006) Intrastromal corneal ring in penetrating keratoplasty: evidence-based update 4 years after implantation. J Cataract Refract Surg 32:993–998

    Article  PubMed  Google Scholar 

  • Kubaloglu A et al (2010) Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus prospective randomized clinical trial. J Cataract Refract Surg 36:1556–1561

    Article  PubMed  Google Scholar 

  • Kymionis GD (2011) Corneal collagen cross linking - PLUS. Open Ophthalmol J 5:10

    Article  PubMed  Google Scholar 

  • Kymionis DG et al (2004) Intacs for early pellucid marginal degeneration. J Cataract Refract Surg 30(1):230–233

    Article  PubMed  Google Scholar 

  • Kymionis DG et al (2007) Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus. J Cataract Refract Surg 33:1982–1984

    Article  PubMed  Google Scholar 

  • Kymionis GD et al (2009a) Intraoperative pachymetric measurements during corneal collagen cross-linking with ribofla­vin and ultraviolet A irradiation. Ophthalmology 116(12):2336–2339

    Article  PubMed  Google Scholar 

  • Kymionis GD et al (2009b) Management of pellucid marginal corneal degeneration with simultaneous customized photorefractive keratectomy and collagen crosslinking. J Cataract Refract Surg 35(7):1298–1301

    Article  PubMed  Google Scholar 

  • Kymionis GD et al (2010) Photorefractive keratectomy followed by same-day corneal collagen crosslinking after intrastromal corneal ring segment implantation for pellucid marginal degeneration. J Cataract Refract Surg 36(10):1783–1785

    Article  PubMed  Google Scholar 

  • Labiris G et al (2011) Corneal melting after collagen cross-­linking for keratoconus: a case report. J Med Case Reports 5(1):152

    Article  Google Scholar 

  • Landesz M et al (2001) Iris-claw phakic intraocular lens for high myopia. J Refract Surg 17(6):634–640

    PubMed  CAS  Google Scholar 

  • Malecaze FJ et al (2002) A randomized paired eye comparison of two techniques for treating moderately high myopia: LASIK and artisan phakic lens. Ophthalmology 109(9):1622–1630

    Article  PubMed  Google Scholar 

  • Maloney RK et al (2002) Artisan phakic intraocular lens for myopia: short-term results of a prospective, multicenter study. Ophthalmology 109(9):1631–1641

    Article  PubMed  Google Scholar 

  • McCall AS et al (2010) Mechanisms of corneal tissue cross-linking in response to treatment with topical riboflavin and long-wavelength ultraviolet radiation (UVA). Invest Ophthal­mol Vis Sci 51(1):129–138

    Article  PubMed  Google Scholar 

  • Meek MK et al (2005) Changes in collagen orientation and distribution in keratoconus corneas. Invest Ophthalmol & Vis Sci Vol. 46, No. 6

    Google Scholar 

  • Menezo JL et al (1996) Iris-fixated Worst claw versus sulcus-fixated posterior chamber lenses in the absence of capsular support. J Cataract Refract Surg 22(10):1476–1484

    PubMed  CAS  Google Scholar 

  • Menezo JL et al (1998) Endothelial study of iris-claw phakic lens: four year follow-up. J Cataract Refract Surg 24(8):1039–1049

    PubMed  CAS  Google Scholar 

  • Menezo JL et al (2004) Phakic intraocular lenses to correct high myopia: Adatomed, Staar, and Artisan. J Cataract Refract Surg 30(1):33–44

    Article  PubMed  Google Scholar 

  • Navas A, Suarez R (2009) One-year follow-up of toric intraocular lens implantation in forme fruste keratoconus. J Cataract Refract Surg 35:2024–2027

    Article  PubMed  Google Scholar 

  • Nuzzi G, Cantù C (2002) Vitreous hemorrhage following phakic anterior chamber intraocular lens implantation in severe myopia. Eur J Ophthalmol 12(1):69–72

    PubMed  CAS  Google Scholar 

  • Park S et al (2010) Late dislocation of intrastromal corneal ring segment into the anterior chamber. J Cataract Refract Surg 36:2003–2005

    Article  PubMed  Google Scholar 

  • Perez-Santonja JJ et al (2009a) Microbial keratitis after corneal collagen corneal crosslinking and bandage contact lens use. J Cataract Refract Surg 35:788–791

    Article  Google Scholar 

  • Perez-Santonja JJ et al (2009b) Microbial keratitis after corneal collagen crosslinking. J Cataract Refract Surg 35:1138–1140

    Article  PubMed  Google Scholar 

  • Pérez-Santonja JJ et al (1996a) Chronic subclinical inflammation in phakic eyes with intraocular lenses to correct myopia. J Cataract Refract Surg 22(2):183–187

    PubMed  Google Scholar 

  • Pérez-Santonja JJ et al (1996b) Endothelial changes in phakic eyes with anterior chamber intraocular lenses to correct high myopia. J Cataract Refract Surg 22(8):1017–1022

    PubMed  Google Scholar 

  • Pérez-Santonja JJ et al (2000) Surgical correction of severe myopia with a angle-supported phakic intraocular lens. J Cataract Refract Surg 26(9):1288–1302

    Article  PubMed  Google Scholar 

  • Pérez-Torregrosa VT et al (1995) Digital system measurement of decentration of Worst-Fechner iris claw myopia intraocular lens. J Refract Surg 11(1):26–30

    PubMed  Google Scholar 

  • Pokroy R, Levinger S (2006) Intacs adjustment surgery for keratoconus. J Cataract Refract Surg 32:986–992

    Article  PubMed  Google Scholar 

  • Raiskup F and Spoerl E (2011) Corneal cross-linking with hypo-osmolar riboflavin solution in thin keratoconic corneas. Am J Ophthalmol (article in press: published online in 28 April 2011)

    Google Scholar 

  • Rama P et al (2009) Acanthamoeba keratitis with perforation after corneal crosslinking and bandage contact lens use. J Cataract Refract Surg 35:788–791

    Article  PubMed  Google Scholar 

  • Rasheed K, Rabinowitz YS (1997) Results of combined lamellar and penetrating keratoplasty for pellucid marginal degeneration. Ophthalmol Suppl; Oct: 191

    Google Scholar 

  • Rodriguez AL et al (2007) Penetrating keratoplasty versus intrastromal corneal ring segments to correct bilateral corneal ectasia: preliminary study. J Cataract Refract Surg 33:488–496

    Article  PubMed  Google Scholar 

  • Rodriguez LA et al (2009) Treatment of six cases of advanced ectasia after LASIK with 6-mm intacs SK. J Refract Surg 25:1116–1119

    Article  PubMed  Google Scholar 

  • Rodriguez-Prats J et al (2003) Intracorneal rings for the correction o pellucid marginal degeneration. J Cataract Refract Surg 29:1421–1424

    Article  PubMed  Google Scholar 

  • Rosen E, Gore C (1998) Staar Collamer posterior chamber phakic intraocular lens to correct myopia and hyperopia. J Cataract Refract Surg 24(5):596–606

    PubMed  CAS  Google Scholar 

  • Rubinstein MP, Sud S (1999) The use of hybrid lenses in management of the irregular cornea. Cont Lens Anterior Eye 22(3):87–90

    Article  PubMed  CAS  Google Scholar 

  • Ruiz-Moreno JM et al (2003) Choroidal neovascularization in phakic eyes with anterior chamber intraocular lenses to correct high myopia. J Cataract Refract Surg 29(2):270–274

    Article  PubMed  Google Scholar 

  • Sansanayudh W et al (2010) Intrastromal corneal ring segment SK implantation for moderate to severe keratoconus. J Cataract Refract Surg 36:110–113

    Article  PubMed  Google Scholar 

  • Schanzlin DJ et al (1983) Crescentic lamellar keratoplasty for pellucid marginal degeneration. Am J Ophthalmol 96(2):253–254

    PubMed  CAS  Google Scholar 

  • Schirmbeck T et al (2005) Efficacy and low cost in keratoconus treatment with rigid gas-permeable contact lens. Arq Bras Oftalmol 68(2):219–222

    Article  PubMed  Google Scholar 

  • Senthil S, Reddy KP (2006) A retrospective analysis of the first Indian experience on Artisan phakic intraocular lens. Indian J Ophthalmol 54(4):251–255

    Article  PubMed  Google Scholar 

  • Sharma N et al (2010) Pseudomonas keratitis after collagen crosslinking for keratoconus: case report and review of literature. J Catarac Refract Surg 36:517–520

    Article  Google Scholar 

  • Spoerl E et al (2004a) Increased resistance of crosslinked cornea against enzymatic digestion. Curr Eye Res 29(1):35–40

    Article  PubMed  CAS  Google Scholar 

  • Spoerl E et al (2004b) Thermomechanical behavior of collagen-cross-linked porcine cornea. Ophthalmologica 218(2):136–140

    Article  PubMed  CAS  Google Scholar 

  • Spoerl E et al (2011) Corneal cross-linking and safety issues. Open Ophthalmol J 5:14–16

    Article  PubMed  Google Scholar 

  • Stulting RD et al (2008) Three-year results of Artisan/Verisyse phakic intraocular lens implantation: results of the United States Food And Drug Administration clinical trial. Ophthalmology 115(3):464–472

    Article  PubMed  Google Scholar 

  • Verma A (2008) Phakic IOL myopia. Available at http://emedicine.medscape.com/article/1221908-overview.

  • Vinciguerra P et al (2009) Intraoperative and postoperative effects of corneal collagen cross-linking on progressive keratoconus. Arch Ophthalmol 127(10):1258–1265

    Article  PubMed  Google Scholar 

  • Wachler BSB (2008) Modern management of keratoconus. Jaypee Brothers medical Publishers, New Delhi: 75–228

    Google Scholar 

  • Weissman BA, Yeung KK (2006) Keratoconus. eMedicine: keratoconus. Available at http://en.wikipedia.org/wiki/Kerato­conus. Accessed 12 Feb 2006

  • Yeung K et al (1995) Clinical experience with piggyback contact lens systems on keratoconic eyes. J Am Optom Assoc 66(9):539–543

    PubMed  CAS  Google Scholar 

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Correspondence to Mazen M. Sinjab M.D., M.S., CABOphth, Ph.D. .

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Sinjab, M.M. (2012). Management of Keratoconus. In: Quick Guide to the Management of Keratoconus. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-21840-8_3

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