Keratoconus Surgery and Cross-linking

by Roberto Pinelli, Antonio Leccisotti

Keratoconus is an ideal link between refractive and corneal surgery. The expansion of the options for the visual rehabilitation in keratoconus has partly originated from the progress of diagnostic and therapeutical techniques in refractive surgery. Intrastromal rings and phakic IOLs, to mention a few, were conceived to correct myopia but have found a natural and successful application in keratoconic eyes. But some of the new techniques discussed in this book were expressly ideated to strengthen (collagen cross-linking) or to replace (lamellar keratoplasty) a weakened corneal stroma. The subject of the surgery of keratoconus has therefore become so wide that no single surgeon can exhaustively cover all its aspects. Corneal transplants have been very successful in the minority of cases requiring it, as many eyes with keratoconus stabilize at a stage where functional vision can be maintained with spectacles, and possibly with insert or contact lenses, although it is recognized that contact lenses can exacerbate progression or cause scarring. We need to find ways to predict the progression of keratoconus in the individual patient and to treat these before there is significant visual loss. So now there is the hope that keratoconus might be stabilized—even modestly regressed—with collagen cross-linking. Time will tell, but we have gone from guarded optimism to unbridled enthusiasm that collagen cross-linking may prove to be very effective in the management of ectasia.

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