PKP
Corneal transplantation is a major surgery which is performed in an operating room. With the advent of newer treatment options, full thickness corneal transplantation (penetrating keratoplasty) is being reserved for select indications of keratoconus when other less invasive procedures are no longer an option. A corneal transplant is warranted for patients with keratoconus when adequate vision can no longer be achieved with contact lenses. This can occur from significant steepening of the cornea, scarring, or contact lens intolerance.
DALK
Corneal transplantation is a major surgery which is performed in an operating room. Lamellar keratoplasty is a less invasive form of corneal transplantation which leaves the inner layer of the cornea (corneal endothelium) intact. This is beneficial as this layer is often healthy in those with keratoconus and this procedure has a reduced risk of rejection versus the traditional full thickness corneal transplantation (penetrating keratoplasty).
Intacs
The Intacs® procedure is a minimally invasive surgical procedure for patients with keratoconus to stabilize the disease, potentially improve vision and enable patients to return to comfortable contact lens wear. Intacs® implants are thin, clear, semi-circular plastic rings which are inserted into the mid-layers of the cornea (corneal stroma). When inserted into a cornea with keratoconus, they work to flatten the cornea, which alters the shape and location of the cone. The placement of Intacs® remodels and reinforces the cornea, helping to reduce irregularities caused by keratoconus and provide more long-term stability. This can improve uncorrected vision; however, depending on the severity of keratoconus, glasses or contact lenses are often still needed for functional vision.
Cross-linking
Corneal cross-linking is a recently FDA-approved treatment for keratoconus that works by strengthening natural bonds between corneal collagen fibers. Corneal cross-linking is a minimally invasive outpatient surgical procedure. The treatment results in a reduction of the risk of progressive weakening associated with keratoconus and post-LASIK ectasia. This has been shown to delay or stop the progression of keratoconus. The effects of the treatment appear to last many years and there is some evidence that the strengthening effect may be permanent. The goal of the treatment is to prevent further decline in vision or need for corneal transplantation, but it does not improve uncorrected vision. Glasses or contact lenses will still be needed following the treatment.
Melanie Frogozo, OD