Optimized Decision-Tree for Keratoconus Management: Considering Clinical Data and Enhanced Diagnostic Approach
Narrative Responses:
Purpose
To present a decision-tree for managing keratoconus (KC) with alternative treatments prior to corneal transplantation.
Methods
A decision-tree was created based on clinical experience and literature review. Five KC cases with different grades of severity were managed based on the decision-tree. Confirmation of the diagnosis of keratoconus and disease severity staging is based on complementary exams, including corneal topography, tomography, biomechanical assessment, and ocular wavefront. Contact lenses provide the best approach for optical correction but does not stabilize the ectatic process. Advise against eye rubbing and ocular surface optimization should be considered for all cases. Indications for surgery include visual impairment not corrected by glasses or contact lenses and evidence of progression.
Results
In Case 1, a conservative approach with contact lenses was selected, after wavefront-assisted manifest refraction and ocular surface optimization. Cases 2 to 5 represent different grades of KC with progressive disease and/or contact lens intolerance. We selected different surgical treatment modalities (alone or combined) based on the advanced ocular analysis. During the postoperative period, the patients achieved a best-corrected visual acuity superior to 20/30 with less complains regarding the optical quality.
Conclusion
This optimized decision-tree was found very useful for the plan of treatment strategy of different stages of KC. The main therapeutic goals were achieved: stop progression of the disease, visual rehabilitation and avoid the need of a corneal transplant.