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Modern Management of Keratoconus Brian S Boxer Wachler

SECTION 1: UNDERATSNDING KERATOCONUS AND KERATOECTASIA
1:What is Keratoconus?
- Introduction
- Incidence
- Conclusion
2:Causes of Keratoconus
- Degradative Enzymes and Their Inhibitors
- Abnormal Stromal Matrix
- Transcription Factors and Signal Transduction Pathways
- Genetics of Keratoconus
- Apoptosis in Keratoconus
- Oxidative Damage in Keratoconus Corneas
- Oxidative Stress as a Final Common Pathway for Keratoconus
- Conclusion
3:Keratoconus after Refractive Surgery (Keratoectasia)
- Introduction
- Biomechanics of Postoperative Corneal Ectasia
- Incidence of Postoperative Keratoectasia
- Diagnosis of Postoperative Corneal Ectasia
- Risk Factors for Postoperative Ectasia
- Recommendations from the Joint AAO/ISRS/ASCRS Committee on Corneal Ectasia after LASIK
- Conclusion
SECTION 2: DIAGNOSING KERATOCONUS AND KERATOECTASIA
4:Clinical Signs
- External Signs
- Retinoscopy Signs
- Slit Lamp Biomicroscopy Signs
- Keratoscopy and Photokeratoscopy Signs
- Conclusion
5:Corneal Topography
- Introduction
- Axial and Instantaneous Maps
- Keratometry Values
- Selecting and Using Corneal Topographers
- Understanding Absolute and Normalized Scales
- Visual Screening of Topography Maps
- Keratoconus and Keratoectasia Topography Patterns
- Artificial Intelligence Methods of Keratoconus Screening
- Conclusion
6:Non-Topography Diagnostic Devices
- Corneal Elevation Maps
- Wavefront Aberrometry Maps
- Pachymetric Maps
- Corneal Hysteresis
- Confocal Microscopy Signs
- Specular Microscopy Maps
- Conclusion
SECTION 3: CORNEA REHABILITATION TREATMENTS
7:C3-R® Corneal Collagen Crosslinking with Riboflavin
- Introduction
- Basic Science Behind C3-R®
- Laboratory Studies
- Clinical Studies
- Our 10-step C3-R® Protocol
- Possible C3-R® Side Effects
  - Epi-on vs Epi-off
- Age Limit for C3-R®
- Combining C3-R® with Intacs®
- Keratoectasia
- C3-R® Pretreatment in Eyes with Keratoconus or Keratoectasia with Planned Future Surface Ablation (PRK)
- C3-R® for Progressive Hyperopia (Farsightedness) after Radial Keratotomy (RK)
- Corneal Melts
- Infectious Corneal Ulcers
- Conclusion
8:Intacs®
- Introduction
- Procedure Technique
- Femtosecond Laser to Create Channels
- Intacs® Selection
- Contraindications
  - Uncontrolled Autoimmune, Collagen Vascular or Immunodeficiency Diseases
  - Pregnant or Nursing Patients
- Considerations
- Potential Side Effects
- Single vs Double Segments Intacs®
  - Intacs® Explant
- Surgical Technique
  - Alternative Technique
- Intacs® Exchange
- Conclusion
9:Ferrara Rings
- Introduction
- Mechanism of Action
- Indications
- Nomograms
- Surgical Technique
- Results
- Efficacy
  - Safety
- Pellucid Marginal Degeneration
- Radial Keratotomy and Astigmatic Keratotomy Ectasia
- Keratoectasia
- Corneal Transplantation
- Combined Intacs and Ferrara Rings
- Conclusion
10:Conductive Keratoplasty
- Introduction
- Surgical Technique
  - CK for Hyperopia
  - CK for Astigmatism in Keratoconus
    - Nuance to Note
- Conclusion
11:Lowering Intraocular Pressure for Keratoectasia
- Introduction
- Conclusion
SECTION 4: CORNEA REPLACEMENT TREATMENTS
12:Lamellar Keratoplasty
- Introduction
- Immunology of the Eye
- Reintroduction of Lamellar Keratoplasty
- Lamellar Keratoplasty
- Keratoconus
- Postoperative Care
- Contact Lens Fitting
- Complications
- Conclusion
13:Penetrating Keratoplasty
- INTRODUCTION
- Immunology Role
- Present Status
- Current Technique
- Postoperative Care
- Complications
- Keratoconus Expectations
- Conclusion
SECTION 5: CONTACT LENSES
14:Contact Lens Fitting Overview
- introduction
- Patient History
- Anatomy
- Physiology
- Lifestyle
  - Career/Hobbies
  - Personality
- Potential Side Effects
- Conclusion
15:Soft Contact Lenses
- Introduction
- Conclusion
16:Rigid Gas Permeable Lenses
- Introduction
- RGP Lens Catagories
- Lens Design Characteristics
- Mathematical Approach to Fitting Using Sagittal Height and Eccentricity
- Mini-scleral and Scleral Designs
- Fitting Process for Mini-scleral Lenses
  - Shape Factor
  - Reference Sphere
    - Example
- Conclusion
17:Hybrid Contact Lenses
- Introduction
- Fitting the SynergEyes® Hybrid Lens
- Determining the Base Curve
- Determining the Skirt Curve
- Conclusion
SECTION 6: TOWARDS THE ULTIMATE GOAL OF REDUCING NEED FOR GLASSES AND CONTACT LENSES
18:Visian ICL and Verisyse Insertable Lenses
- Visian ICL
  - Advantages of the Visian ICL
- Verisyse lens
  - Advantages of Verisyse Lens
- Comparison of Visian ICL and the Verisyse Lens
  - Both Phakic Intraocular Lenses
  - Differences between the Visian ICL and Verisyse Phakic Intraocular Lens
- Conclusion
19:PRK and C3-R®
- Introduction
- Nomogram Adjustments
- Can LASIK “Regressions” be a Form of Ectasia?
- Conclusion

INDEX

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Chapter Notes