In Keratoconus, there are many options, that have to be individualised for each patient. Most corneal specialist agree, that there is two different goals in the treatment of keratoconus: First, stabilise the progressing disease and second, improve the vision if required.
1. Stabilising the corneal shape by UV-Crosslinking:
If the keratoconus is progressing, the process can be stopped by a special UV light treatment. Using UV light with a wavelength of 370nm to stiffen the cornea will not only allow the corneal shape to stabilize, but often shows significant flattening of the corneal topography, improving vision or improving contact lens intolerance.
2. Improve the Vision
a) Special contact lens fitting
Improving the vision can be achieved in most cases with fitting of special contact lenses by your optician or optometrist. That contact lens fitting is often more complicated and needs a specialised optician or optometrist. That is why not all optical stores can manage the complicated fitting which can sometimes be difficult and frustrating.
The patients topography can be individually improved by the application of a special laser treatment (TG-PRK ). As the already weak cornea will get thinned by the laser treatment, a combination with a stabilising UV-Crossling procedure is recommended.
c) Intracorneal Rings
With intracorneal rings, topography is improved by the insertion of special rings. Firstly, a laser systems prepares a 360° ring-snapped channel in the cornea. One or two rings are then inserted in previously calculated positions and a single suture is necessary to close the entry wound. The procedure is relatively fast and simple and rings can be removed if not successful.
If the Keratoconus is in an advanced stage and vision can not be satisfactionally improved or the cornea is scarred, corneal transplantation might be the best option to improve the vision.
Transplanting only the superficial part of the cornea might has several advantages with stability, endothelial cell density and rejection rate, but is surgically challenging. (Deep anterior lamellar keratoplasty). Another possibility is transplanting a full thickness corneal tissue (perforierende Keratoplastik).