Screening Procedures and Surgical Management of Keratoconus in European Ophthalmological Practice
Narrative Responses:
Purpose
To document a management process for all grades of eye keratoconus disease in a large group of patients and relatives with reference to Cross linking (CXL), Intracorneal rings (ICR) and Deep Anterior Lamellar Keratectomy (DALK).
Methods
All young person's presenting with myopia with or without astigmatism, the immediate relatives of KC patients and Down's Syndrome were screened topographically for evidence of Forme Fruste (FF) and active KC. FF and early KC cases were monitored every six months for progression and referred for CXL if seemed to progress. Only advanced cases with astigmatism up to 58D were first treated with CXL some of which were followed by ICR six months later. Cases with apical scarred corneas and gross astigmatism were referred for DALK. Finally contact lenses were used to optimize and rehabilitate vision if necessary.
Results
In a period of 5 years (2008-2013) 203 patients (365 eyes with KC) were treated with either CXL alone (47 eyes). Femtosecond ICR either alone or combined with CXL (23 eyes) and DALK in 12 eyes for more advanced cases. Visual results were excellent and will be reported in the final presentation.
Conclusion
In view of the fact that early treatment with XCL is so successful in stabilization of KC, the use of contact lenses is considered more appropriate for visual rehabilitation of patients who have been treated with the above treatments.