Surgical Options for Keratoconus

Corneal Cross Linking (CXL)

This is a relatively new procedure to the UK, although it has been used in Germany, where it was developed by Dr Theo Seiler, for over 11 years. It uses UV light to activate Riboflavin drops absorbed into the cornea which then improves the cross linkage between collagen fibres in the cornea. This acts to stiffen the cornea and appears to stop progression in its tracks. Thus it is seen as a real way forward in the treatment of keratoconus where previously all other options were aimed at managing the condition.

LWVC CXL Page

CXLCLUB

INTACS

Intrasomal Corneal Rings are semi-circular plastic rings which are inserted into the cornea. These act to support and reshape the cornea, often improving vision markedly. They are not suitable for everyone and sometimes have to be removed of irritation or awareness of reflections from them. They appear to be more effective when used in conjunction with CXL and in many cases allow the person to be able to use glasses again.

Phakic Implants

These are plastic implants inserted into the anterior chamber of the eye and can correct high refractive error and astigmatism. These are also used now in conjunction with CXL, the idea being to stabilise the keratoconus and then correct the refractive error totally with the phakic implant. One drawback might be if the cornea has large Higher Order Aberrations (these cause ghosting and multiple images), they would not be corrected by the phakic implant.

Corneal Graft

A graft is really the last resort for a keratoconic. This involves removing the central part of the cornea and replacing it with a donor “button”. Fully penetrating grafts replace the entire cornea. DALK (Deep Anterior Lamellar Keratoplasty) leaves the back layer of the host cornea (the endothelium layer) intact. Grafting should only be considered when there is deep central scarring which reduces vision greatly. Very often grafting is offered when it is difficult to obtain a good contact lens fit on an otherwise clear cornea. With so many contact lens options available now, every avenue should be explored before this step is taken.