Irregular curvature of the cornea so when. This insidious keratoconus is the fight against corneal pathology

Keratoconus is a painful deviation of the eyes with changes in the structure of the cornea, which becomes thinner and curved from exposure intraocular pressure. Deformation changes the shape of the cornea to a cone. The refraction of rays passing through the conical cornea becomes irregular, distorting images and impairing visual acuity. The disease is called keratoconus, which translated from Greek means “cone cornea”.

Keratoconus is most often diagnosed in adolescents during puberty. Quite rarely, keratoconus occurs in children and people over thirty years of age. The disease is fixed in 3-4 people per 100 inhabitants. No later than 20 years after its manifestation, the disease stops developing. However, in very advanced cases, corneal rupture and even loss of vision are possible.

IN international classification diseases ICD-10 keratoconus has a code H18.6.

Classification

Keratoconus can be unilateral, when only one eye is affected, or bilateral. Statistics show that about 95% of all cases of the disease occur in both eyes.

Due to appearance:

Primary, caused by genetic factors;
Secondary, resulting from adverse effects external environment, surgical operations on the organs of vision, the consequences of injuries.

According to the course of the disease:

Acute;
Chronic;
With variable current.

Deviation of vision from the norm with keratoconus is divided into 3 stages:

Weak, with a value of up to 40 diopters. During this period, slight morphological changes occur in the cornea of the eye, signs of astigmatism appear;
Average degree, no more than 55 diopters. Cracks in the Descemet's membrane of the cornea form, allowing moisture to pass through from the anterior chamber. The apex of the cone takes on a cloudy outline, and the patient practically ceases to see in the dark;
Severe, with a diopter value of more than 55. Visually, the unnatural shape of the cornea is already noticeable; it can become completely cloudy. Vision deteriorates sharply, the person sees poorly even during the day. At high probability A corneal rupture requires urgent surgery.

The level of corneal dystrophy can be:

Moderate, with its thickness close to 0.5 mm;
Medium, with a value of 0.4–0.5 mm;
Over-permissible or close to rupture, with a thickness of less than 0.4 mm.

According to the degree of corneal deformation, the following forms are distinguished:

Point dome. The pathology has a diameter of about 5 mm and is located in the center of the cornea;
Oval dome shape. The cornea protrudes up to 6 mm, its deformation is localized below the center and sags;
Ball-shaped deformation. The cone is more than 6 mm, the disease covers up to 70% of the cornea.

Causes of keratoconus

Oddly enough, doctors have not yet come to a consensus on what causes the occurrence of keratoconus. Among the most common theories of origin are:

Hereditary or genetic predisposition;
Negative consequences after laser vision correction;
Unfavorable ecology, influence of ultraviolet radiation;
A consequence of improper selection of contact lenses, which cause injury to the cornea;
Eye injury as a result mechanical impact and even the habit of rubbing your eyes;
Disturbances in the endocrine system, dysfunction hormonal levels, disruptions in the metabolic process.

Another theory is that the cause of keratoconus is the consequences of previous infectious diseases, since in most cases it occurs in children with weak immunity. Some researchers associate the occurrence of keratoconus with mental trauma, stress and nervous experiences.

Symptoms of keratoconus

Initially, symptoms of keratoconus are similar to other eye diseases. A person complains of severe eye fatigue, double images when looking at light objects on a dark background, the appearance of spots before the eyes, and the presence of discomfort. If the process of development of pathology begins to progress rapidly, visual acuity will decrease, as happens with myopia or astigmatism. In the early stages, wearing glasses or contact lenses helps overcome visual impairment; later, optical correction loses its effectiveness.

Vision in keratoconus decreases gradually. Due to the increase in the number of diopters, the patient has to change glasses frequently. However, this cannot always guarantee a positive result. Pathology can sometimes progress so quickly that changing glasses does not have time to adjust vision. also cannot be of benefit due to abnormal corneal bulge. In this case, the patient should begin serious treatment of the visual organs.

Typically, the stages of development of keratoconus continue for 10–15 years, sometimes this is delayed for a longer period of remission. Only in 5% of cases does the disease suddenly develop into an acute form, in which Descemet’s membrane ruptures and intraocular fluid leaks out.

Diagnosis of keratoconus

The beginning of detection of ocular keratoconus is the moment the patient contacts an ophthalmologist with a complaint of deteriorating vision. After the interview, the doctor measures visual acuity and eye refraction. If the presence of myopia or farsightedness is not confirmed, the examination of the patient will continue. Exist following methods diagnostics:

Skiascopy. Using a special device (skiascope), the counter-movement of shadows specific to keratoconus, called the “scissors effect”, is determined;
Keratometry is the most common diagnostic method in which the curvature of the cornea is determined;
Refractometry. Using the technique, irregular astigmatism and myopia resulting from corneal deformations are detected;
Computed tomography of the eye or ultrasound. These studies reveal changes in the tissues of the cornea, including scars on its surface.

In the later stages of the disease, its diagnosis is not difficult, since the pathology of the cornea is immediately visible without special devices. Only examinations are required to determine the extent of damage to the eye tissue. Once the diagnosis is confirmed, some additional examinations will be required from related specialists.

Treatment of keratoconus

Treatment of keratoconus of the eye with medications, unfortunately, is not yet possible. Taufon and others similar drugs designed to nourish eye tissue and relieve burning and dryness in visual organs. Therefore, such medications can only be part of complex therapy when choosing a specific treatment method.

At initial stages keratoconus apply conservative methods treatment. More severe forms of keratoconus require surgical intervention. Traditional medicine is also used.

Vision correction with glasses is prescribed first. While their use brings a therapeutic effect, the use of contact lenses is not allowed. The reason is quite clear: lenses can cause microtrauma to the surface of the eye.

Only when the situation with the conicity of the cornea changes the refraction of the image does the selection of glasses stop. This optical device is being replaced by lenses, the selection of which occurs individually, taking into account the stage of the disease and the capabilities of the body:

Soft lenses do not scratch the cornea, but their use can correct vision only when it protrudes slightly. Practice shows that such lenses are not very suitable for keratoconus: taking the shape of the cornea, they do not create a tear film, which is why the refractive power of the eye does not improve;
Hard lenses are made individually and therefore have a great therapeutic effect. While maintaining their shape, they are able to eliminate curvature of the cornea. A tear film can already form between these lenses and the eye. The disadvantage of lenses is that they create discomfort when worn on a damaged cornea;
Hybrid lenses consist of a hard center and a soft rim, combining benefit and comfort. Recommended for those who wear hard lenses causes great inconvenience.

The development of medicine has made it possible to develop several options for surgical correction, but only a doctor should make the choice in favor of a specific operation. The most modern method It is considered the introduction of colorless rings into the corneal tissue (implantation of intrastromal rings), which will bring its shape closer to natural. However, surgery is not able to stop the course of the disease.

Eye surgery is modern and safe method treatment and has a short rehabilitation period.

Also popular is an operation in which donor tissue is placed in place of the damaged one. It is recommended for severe deformation of the cornea as a result of other treatment methods, but carries the risk of dangerous complications such as glaucoma and rejection of the transplanted tissue. Finally, in the most advanced cases, a corneal transplant is used. This operation is the only way to stop the course of the disease. The most qualified clinic for the treatment of keratoconus is in Moscow.

Traditional methods should be resorted to early stages disease to slow down the progression of pathology. You can use traditional medicine during the rehabilitation period, but you need to understand that it is impossible to straighten the cornea using these methods. But compresses prepared from chamomile flowers help relieve eye itching, relieve excessive tension from the sore spot.

Keratoconus and the army

“Do they take people with keratoconus into the army?” - the question is very important and has a big social aspect, since, as mentioned earlier, keratoconus is a disease of the young, and its first signs may appear shortly before conscription. It should be noted right away that people with such a disease are not accepted into the army. Moreover, if there is a suspicion of keratoconus of the eye, then the young man receives a deferment from conscription for six months. After a specified period of time, the diagnosis must either be confirmed or refuted.

In this situation, you need to clearly understand that any military registration and enlistment office has its own medical commission, which evaluates the health of the conscript, and only it has the right to decide whether the patient is fit for military service or not. Ordinary ophthalmologists cannot make such decisions on commission.

Prevention of keratoconus

To minimize the occurrence of keratoconus, young people first of all need to regularly visit an ophthalmologist and follow all his recommendations. When found inflammatory processes in the organs of vision, prompt measures should be taken to eliminate them.

While reading, working at the computer, or watching TV, it is necessary to control the strain on the eyes. To prevent excessive strain, it is necessary to provide sufficient lighting for work or activities that require concentration and attention to the eyes.

Should not be neglected protective equipment under circumstances that may harm the eyes: dusty air, cold wind, bright light.

Proper nutrition and lifestyle without bad habits will benefit the entire body and the eyes in particular. It is important to take prompt measures when allergic processes occur and maintain eye hygiene by washing them with decoctions of healing plants.

The term keratoconus comes from two Greek words: “kerato”, meaning “cornea”, and “konos” - “cone”. Keratoconus is a degenerative eye disease in which the cornea due to structural changes thins out and takes on a conical shape as opposed to the normal spherical one. This pathology usually occurs in adolescence, but sometimes also occurs in children and young people under 30 years of age. Changes in the shape of the cornea occur slowly, usually over several years. However, there are also cases of more rapid progression of keratoconus.

The earliest references to keratoconus belong to the German doctor B. Mohort (dating back to 1748) and Taylor (1766), but for the first time the disease was described in detail and isolated from the group of other corneal ectasias by the British D. Nottingham in 1854. At that time, the treatment of keratoconus was reduced to cauterization of the cone-shaped part of the cornea with silver nitrate and the application of a tight bandage in combination with the instillation of drugs that cause miosis.

In 1888, the French ophthalmologist Eugène Kalt began work on a glass shell designed to flatten the steep conical apex of the cornea and thereby correct its shape. This is the first known use of contact lenses for the correction of keratoconus.

Symptoms

The first signs of keratoconus are often the need for frequent changes glasses and blurred vision, not corrected by them. Classic symptom of this disease is the appearance of multiple virtual images, known as monocular polyopia. This effect is most noticeable when viewing high-contrast visual images, such as a light dot on a dark background. Instead of seeing a single point, the eye with keratoconus sees a chaotic pattern of many images.

Causes

Despite extensive research, the etiology of keratoconus remains unknown. Presumably, this disease has several causes. These include: genetic predisposition, stress, corneal trauma, cellular factors and influence environment. All of them can serve as an impetus for the development of keratoconus.

Classification of keratoconus

Based on the amount of corneal curvature, the following types of keratoconus are distinguished:
- mild (less than 45 D)
- medium (from 45 to 52 D)
- developed (from 52 to 62 D)
- severe (more than 62 D)
Based on differences in cone shape morphological classification:
- mastoid - has a small size (up to 5 mm) and is located closer to the center of the cornea
- oval - 5-6 mm in size, usually shifted downward from the center
- spherical - dimensions exceed 6 mm, in pathological process More than 75% of the cornea is involved.

The advanced stage of keratoconus can sometimes progress to corneal hydrops, also called “acute keratoconus,” when fluid penetrates into the stroma through breaks in Descemet’s membrane, leading to its edema and, possibly, secondary severe scarring of the cornea.

Diagnosis of keratoconus

With technical improvements in medical equipment used to perform topographic mapping and measurement of the cornea, it has become much easier for ophthalmologists to diagnose keratoconus and choose more effective methods treatment.

Keratoconus is often difficult to detect on early stages, as vision suffers still slightly. One of the early signs that cause concern to the ophthalmologist is the difficulty of achieving maximum visual acuity in the patient, even with ideal spectacle correction.

Other clinical findings that help confirm the presence of keratoconus include thinning of the corneal stroma, deposits of iron oxide (hemosiderin) in the basal layer of the epithelium (Fleischer's ring), and breaks in Bowman's membrane. All of them can be identified by examination with a slit lamp. In addition, the presence of keratoconus is determined using devices such as a retinoscope and keratometer. They make it possible to detect signs irregular shape cornea.

Ultrasound and other pachymetry methods are certainly useful in confirming the diagnosis of keratoconus, as they are used to measure the degree of corneal thinning in patients suspected of having the disease. Equipment from some manufacturers, in particular from Bausch & Lomb and Orbscan, combines the capabilities of various methods for conducting these examinations in order to more accurately establish a diagnosis.

Treatment of keratoconus

Not currently known medical supplies leading to regression or prevention of the development of keratoconus, but patients are able to slow the progression of the disease by refraining from rubbing their eyes. In cases where glasses or soft contact lenses are no longer effective, conservative (rigid contact lenses) and surgical treatment methods are used, including penetrating and lamellar keratoplasty, implantation of intrastromal corneal rings, epikeratophakia, asymmetric radial keratotomy, corneal collagen cross-linking.

Contact lenses for keratoconus

Refractive error
for keratoconus

Correction of keratoconus
contact lens

In the early stages of keratoconus, distortion of visual images is corrected with the help of glasses that correct the slight myopia and astigmatism that are caused by this disease. At an advanced stage, contact lenses are the first choice for vision correction. In most cases, the mode of wearing them is permanent. There is no single lens design that is ideal for any type or stage of keratoconus. Required individual approach to each patient in order to make a carefully considered decision about the use of certain contact lenses that allow them to achieve the best combination of visual acuity, comfort and corneal condition.

Soft contact lenses
The possibility of using soft contact lenses is limited due to the fact that such a lens, covering the irregular surface of the cornea, takes its shape. At the same time, a space filled with tear fluid is not created between them, which, in turn, does not contribute to increasing the efficiency of the refractive surface of the cornea in comparison with the original one in keratoconus.

Rigid gas permeable contact lenses
Rigid gas permeable contact lenses are the main method of vision correction for keratoconus. They correct the irregular shape of the cornea and, together with the tear film that fills the space between the contact lens and the outer surface of the cornea, function as a new refractive surface in the eye. The term “rigid” defines the type of lens, while “gas permeable” describes the properties of its material. There are many different models of hard contact lenses.

"Double-layer" lenses
Combined "double-layer" lenses can be used in difficult cases, for example, with individual intolerance to rigid gas-permeable contact lenses, severe central opacities of the cornea with keratoconus, thinning of the apex or recurrent epithelial erosion. This system consists of a rigid lens mounted on top surface soft. Its goal is to maintain visual acuity using one lens that combines the advantages of two types of lenses.

Hybrid lens system
Softperm contact lenses (Ciba Vision) belong to a hybrid lens system and are rigid gas permeable lenses with a soft hydrophilic edge. They are usually used in cases of individual intolerance to hard lenses. Softperm lenses have many advantages. They provide greater comfort compared to hard ones. gas permeable lenses, better centering on the eye and acceptable visual acuity. But these lenses are generally used only in exceptional cases due to the risk of induced corneal edema and neovascularization.

The main disadvantages of Softperm lenses are frequent breakage, the development of giant papillary conjunctivitis and peripheral corneal neovascularization. It should be noted that this type of lens was originally intended to treat not keratoconus, but the cornea normal form. But due to the fact that these lenses provide wearing comfort soft lenses and visual acuity, as in hard ones, they began to be used by patients with keratoconus, who inevitably exceeded the recommended periods of wearing them, which ultimately led to complications.

Scleral lenses
These are large diameter lenses that rest on the white outer layer of the eye, called the sclera, while completely covering the cornea. Their size may seem intimidating, but wearing them has many benefits. Due to their size, scleral lenses do not fall out of the eye, and dust and dirt particles cannot get under them while being worn. These lenses are very comfortable to wear, as their edges are hidden under the edges of the upper and lower eyelids, making them invisible.

Crosslinking

Crosslinking is new method stopping the progression of keratoconus. The full name is “corneal collagen cross-linking with riboflavin (abbreviated as C3R/CCL/CXL).” This is a procedure that increases the stiffness of the cornea, allowing it to resist further deformation.

With keratoconus, the cornea weakens, thins, and its shape becomes more convex, with the development of irregular astigmatism. Cross-linking strengthens the connections between collagen microfibrils in the cornea, as well as between and within the molecules that form these microfibrils. This is achieved by using the non-toxic substance riboflavin (vitamin B2), which acts as a photosensitizer. Dosed ultraviolet irradiation in the long-wave range (UV-A) causes the formation free radicals inside the cornea and, as a result, chemical cross-links (“cross-links”).

In practice, the crosslinking procedure is simple and gentle for the patient. Local anesthetic drops are instilled into the eye before removing the corneal epithelium in the central part. Riboflavin solution is used to saturate the stroma for 30 minutes before ultraviolet irradiation, which is also carried out for 30 minutes using a precisely calibrated instrument such as the UV-X system. Postoperative care is essentially the same as after excimer laser photorefractive keratotomy and includes wearing a therapeutic contact lens, as well as local treatment over the next 3 days to increase comfort and accelerate epithelization.

An increase in the number of connections between collagen fibrils in the cornea gives it stiffness, similar to that observed during natural aging. The biomechanical strength of the human cornea can be increased by 2-3 times. It is believed that this increased rigidity is what slows or stops corneal ectasia.

The crosslinking technique using a riboflavin solution in combination with exposure to long-wave ultraviolet light was developed in Germany in 1993, and the first operation using this technique was performed in 1998. It has been steadily gaining momentum since the results of clinical trials became available, ongoing at several centers around the world, and the FDA recently approved a cross-linking study.

Published data clearly show no progression of keratoconus over a 3- to 5-year period after the procedure. For example, in a Dresden study on 60 eyes after cross-linking there was no observed further development process, and in more than half of them there was some flattening of the cornea by up to 2.87 D. A slight improvement in visual acuity was also detected: with optimal correction - by 1.4 lines.

Potential candidates for cross-linking are those who have progression of keratoconus or other keratoectasia (transparent marginal corneal degeneration, iatrogenic cases). For surgery, the corneal thickness must be at least 400 microns to provide endothelial protection from potentially toxic ultraviolet radiation (UVA) index 8 after epithelial removal. This parameter is measured before treatment begins: if the cornea is too thin, then a hypertonic riboflavin solution may be used to cause sufficient swelling to allow the procedure to be performed safely. During the use of this method, no dangerous side effects were identified.

It is important to understand that collagen cross-linking is not a panacea for the treatment of keratoconus, but rather is aimed at stopping the progression of this disease. After the procedure, patients will continue to wear glasses or contact lenses, although their prescription may need to be changed. The main goal of cross-linking is to arrest the progression of keratoconus and thereby prevent further deterioration of vision and the need for corneal transplantation.

Radial keratotomy in the treatment of keratoconus

This type of surgical intervention is not generally accepted, and there is currently no reliable data on its safety and effectiveness. The opinions of ophthalmologists, as well as the available research results on this issue, are contradictory. Those few who perform it speak about the effectiveness of the technique: it combines not only stabilizing properties regarding the progression of keratoconus, but also refractive ones that correct ametropia and help improve visual acuity. Unfortunately, it is not possible to conduct adequate research for various reasons, so it is necessary to consider this technique experimental.

Below are the options for performing keratotomy for keratoconus.

Asymmetrical radial keratotomy
The “mini” technique of asymmetric radial keratotomy (ARK) is sometimes identified with its predecessor, radial keratotomy, which is not entirely true. This is special surgical procedure, in which micro-incisions are made on the cornea in such a way as to smooth out or enhance the irregular shape of the cornea.

The technique began many years ago, and the person who had the greatest influence on its development was the outstanding Russian ophthalmologist Svyatoslav Fedorov, the father of modern radial keratotomy.

Professor Massimo Lombardi, who studied with Fedorov for a long time, developed the technique and adapted it specifically for the treatment of keratoconus. After many years of testing and technical improvements, an asymmetrical “mini” surgical technique was developed. The “Fedorov” radial keratotomy had to be adapted to combat the variability in corneal shape in each case and the unevenness of its thickness characteristic of keratoconus. For this reason, the incisions were shortened and limited to the central optical zone.

The procedure is individual for each patient and requires a thorough assessment of the indications for it and preoperative examination. The cornea is carefully scanned and mapped in detail. After perimetry and other examinations, it is calculated where, to what depth, what length, at what angle, etc. every cut will be made. This outpatient procedure is performed under local anesthesia and lasts 1-3 minutes on one eye.

The surgeon's experience plays a very important role when performing this procedure, since it takes many years to learn how to use this method to treat keratoconus. For this reason, ARC is not widespread. According to the author, the fact that the treatment of a patient with keratoconus is selected taking into account the specific, individual in each case, corneal profile makes it possible to obtain optimal results from this surgical intervention.

Optical Diamond Surgery
The technique of optical diamond surgery, developed by Academician Artsybashev, according to the author, allows you to maintain stable results even 20 years after the operation. It not only stops the progression of keratoconus, but also improves visual acuity. Incisions made using this method for keratoconus due to the redistribution of intraocular pressure exerted on the corneal tissue lead to a change in its irregular shape and, as a result, to partial or full restoration functions. After surgery, in most cases, the cornea is completely restored, and visual acuity increases. This method used to preserve the patient's own cornea and prevent acute keratoconus requiring corneal transplantation or keratoplasty.

The operation is performed on an outpatient basis, under local anesthesia and lasts 2-3 minutes. Patients are discharged from the hospital on the first day after surgery. Its results are felt the very next day. Patients are under medical supervision, control examinations are carried out one, three, six months, one and two years after the intervention. Also developed postoperative treatment, providing conditions for better scarring of microincisions, which creates the basis for strengthening the cornea. Since 1983, Dr. Artsybashev has performed more than 1,000 operations for stages I-IV of keratoconus, and more than 30,000 refractive operations to improve the optical function of a healthy cornea. Each operation was planned taking into account the exact individual shape of the cornea, so a thorough preoperative examination is necessary.

In the end, I would like to remind you once again that all the described keratomy options are not included in any protocol for the treatment of keratoconus and cannot be recommended for use along with the generally accepted ones. The methods require full-fledged research, based on the results of which a decision can be made to introduce them into global practice or complete ban for carrying out these interventions in ophthalmology.

Intrastromal corneal rings

Newest surgical method To correct irregular astigmatism in keratoconus, an alternative to corneal transplantation is the implantation of intracorneal ring segments (keraring).

Currently, two types of intrastromal rings are available: Intacs, which have a hexagonal cross-section and are installed further from the center than the second type - Ferrara Rings, which have a triangular prism. The rings can be implanted deep into the middle of the corneal substance (stroma). The operation is carried out quickly and painlessly, in outpatient setting using anesthetic drops. In this case, a specially designed vacuum layer-by-layer dissector is used, creating an arc-shaped pocket for rings, or, according to latest technology, femtosecond laser. The exact mechanism of action of the rings is not understood, but it is believed that they exert buoyant pressure directed outward from the curvature of the cornea, flattening the apex of the cone and returning it to a more natural shape. Previous studies also assign a large role in this process to the thickening of the overlying epithelium adjacent to the segments, which gives a significant leveling effect.

Intrastromal corneal rings Ferrara Rings differ from Intacs in that they have a smaller radius of curvature (in the former it is fixed and is 2.5 mm, in the latter it can vary from 2.5 to 3.5 mm), and also in the fact that, despite smaller size, there is less chance of glare after installation due to the prismatic shape. Any light beam that hits the ring is reflected in the opposite direction so that it does not enter the field of view. Because Ferrara Rings are smaller and positioned closer to the center of the cornea, they provide a stronger effect and can correct myopia up to −12.0 D, more than can be corrected with Intacs rings. The appearance of glare was noted in some patients with large pupil diameters. In such cases, it is recommended to install Intacs.

As a rule, the results of treatment in most patients are positive, as evidenced by a significant decrease in the degree of astigmatism after surgery, accompanied by an increase in visual acuity both with and without optimal spectacle correction. So far, the groups of patients studied for the most part remain small, but favorable outcomes have been achieved within 24-36 months of follow-up. The best results were obtained on eyes with light and medium shape keratoconus.

Perforation of the anterior chamber during surgery, lack of the expected result, infection, aseptic keratitis, postoperative extrusion (pushing out) of the ring are included in the list of possible complications. Removing problematic segments can be easily done. This allows the cornea to return to its original preoperative state. Studies have shown that in approximately 10 percent of cases, it becomes necessary to remove the rings, either due to the complications listed above or due to lack of effect. But this does not exclude the possibility of subsequently performing layer-by-layer or penetrating keratoplasty.

Corneal transplantation

Corneal transplantation, or keratoplasty, is a surgical procedure to remove damaged corneal tissue and replace it with healthy tissue taken from the eye of a suitable donor. It can improve vision and relieve pain in an injured or diseased eye.

Keratoplasty is usually indicated in cases where the cornea is severely deformed after treatment with other methods or when it is damaged due to disease, infection or injury.

A corneal transplant involves removing part (layered keratoplasty) or all of the layers (penetrating keratoplasty) of clouded or deformed tissue and replacing it with a graft taken from a deceased donor.

Dr. Edward Zirm in 1905, on the territory of the present Czech Republic, was the first in the world to perform successful transplant cornea to a person, and the graft remained viable throughout the patient’s future life. Since that time, a number of new techniques for this operation have been developed. The most common method of corneal transplantation is penetrating keratoplasty.

Keratoplasty (penetrating keratoplasty or corneal transplantation)
Penetrating keratoplasty (see photo) includes complete removal cornea (all 5 layers) and replacing it with a donor one, which is sewn into place so that the distance between adjacent seams is 20 microns (40% of the thickness of a human hair!).

Usually the sutures are removed after a year. The same amount of time may be needed to restore vision to a satisfactory level. Often, patients who have undergone penetrating keratoplasty need to wear glasses or contact lenses to correct their vision. Graft survival after this operation averages 15 years.

Deep anterior lamellar keratoplasty (DALK)
Such surgical intervention is performed in cases where the endothelium lining the inside of the cornea is healthy, and the stroma is pathologically altered. The operation allows you to remove the affected stroma and preserve healthy underlying tissues of the deep layers. The pathologically changed anterior part of the cornea is removed and replaced with a new donor one, which is fixed with small sutures. The graft lies on top of the patient's own tissues, lining the inside of the cornea. Since its internal layers do not shift, the risk of rejection is lower, and the prognosis for long-term graft survival is better. However, the patient after deep anterior lamellar keratoplasty faces a longer recovery period, in addition, the same quality of vision is not always achieved as with penetrating keratoplasty.

Risks of Corneal Transplantation

Corneal rejection
Rejection is the process by which the patient's immune system recognizes the donor cornea as foreign and mounts an immune response against it. Such cases are very common and occur in every fifth transplant patient. Most rejections are suppressed effective treatment, the graft takes root and continues to function. The key to a successful outcome is timely initiation of treatment. At the first onset of rejection symptoms, patients should urgently consult a specialist. Symptoms to look out for include:
photophobia, or photophobia increased sensitivity to bright light);
irritation or pain;
redness;
decreased or blurred vision.
Treatment consists of instillation of steroid eye drops and, sometimes, orally or parenteral administration drugs of this group.

Infection
The surface of the graft can become infected if the sutures holding it in place become loose or ruptured. In cases where the infection cannot be controlled, this can lead to death of the transplanted tissue or loss of the eye.

Glaucoma
This is an increase in intraocular pressure that damages the optic nerve at the back of the eye. Steroid medications used after corneal transplantation may cause glaucoma in some patients.

Retinal disinsertion
It is observed in approximately 1% of patients after penetrating keratoplasty. Can be treated with subsequent surgery.

Keratoconus– a term made up of two Greek words: “kerato” and “konos”, which are translated from Greek language, as in "cornea" and "cone". Actually, the name perfectly reflects the essence of the disease: with keratoconus, the cornea of the eye, due to degenerative changes, becomes thinner, and instead of normal spherical shape takes the shape of a cone.

Usually, similar problem occurs in adolescent children, but sometimes keratoconus can be found in very young children, and even in people in their thirties. Typically, the transformation of a spherical cornea into a cone occurs rather slowly, taking several years. True, sometimes there are cases and the rapid development of the disease.

The first mention of the disease dates back to the 18th century (B. Mohort, Taylor), but it was described in detail a century later, when the British ophthalmologist D. Nottingham isolated it from the group of other corneal ectasia in 1854. Treatment for keratoconus in those days was carried out by cauterizing the cornea with a solution of silver nitrate, after which a thick bandage was applied to the eye and drops were prescribed that caused miosis.

A little later, the Frenchman Eugene Calt began working on the manufacture of a special glass shell, which, when placed on the eye, would flatten the conical top of the cornea and correct its shape. This experiment is considered to be the first mention of the treatment of keratoconus with contact lenses.

Symptoms of keratoconus

The initial sign of keratoconus is usually blurred vision, which cannot be corrected even with frequent changes of glasses. The identifying sign of this disease is the appearance of multiple phantom images, called monocular polyopia. This effect is especially common with visible objects of high contrast, for example, when viewing dark dots on a light background. In this case, instead of a single point, a person with keratoconus observes a picture with many chaotic images of it.

Causes of keratoconus

Serious research conducted in the field of keratoconus has not yet been able to establish the exact cause of the disease. Presumably, several factors contribute to the occurrence of keratoconus, such as: genetic predisposition, corneal trauma, decreased gland function internal secretion, viral infections (hepatitis B), stress, allergies, adverse effects of the external environment. Each of them can serve as a trigger for the development of the disease.

Video about the causes and symptoms of keratoconus

Classification of keratoconus

Today in ophthalmology there are at least five different classifications of the disease, but the classification according to M. Amsler is most often used. It is based on the biomicroscopy features of the cornea with ophthalmometric changes. According to her, there are 4 stages of the course of the disease:

Stage one: visual acuity 0.1-0.5, with the possibility of correction with cylindrical glasses, corneal curvature - over 7.2 mm.
Stage two: visual acuity up to 0.1-0.4, there is the possibility of correction with cylindrical glasses, thinning of the cornea and slight ectasia are possible, corneal curvature is 7.19-7.1 mm.
Stage three: visual acuity 0.02-0.12, there is the possibility of correction only with hard-tolerate hard lenses, the radius of curvature of the cornea is 7.09-7.0 mm, noticeable protrusion of the cornea and its thinning, opacities in the Bowman's membrane.
Stage four: terminal with opacities of the corneal stroma, damage to Descemet's membrane. The curvature of the cornea is no more than 6.9 mm, visual acuity is not corrected, amounting to 0.01-0.02.

In addition, it is customary to distinguish:

Anterior keratoconus(true). Him chronic course with pathological processes occurring in Bowman's membrane. Its difference is in the occurrence of almost transparent ectasia.
Acute keratoconus(hydrops) - dropsy of the cornea. The condition is accompanied by damage to Descemet's membrane, when intraocular moisture, due to a change in barrier function, enters the layers of the cornea, causing clouding and swelling of the stroma.
Posterior keratoconus– an anomaly caused by underdevelopment of the mesoderm. It is distinguished by centrally formed thinning, sometimes in the shape of a saucer. The cornea is almost flat, optically weak. The condition has been stable for a long time.

Diagnosis of keratoconus

The development and improvement of special ophthalmological equipment for measuring the cornea and topographic mapping has greatly facilitated the diagnosis of keratoconus, which also has a positive impact on the choice of treatment methods.

Very often, the disease is almost impossible to detect in the earliest stages of its occurrence, since visual functions are almost unchanged. Most early sign Keratoconus, which does not go unnoticed experienced specialists, - difficulty in achieving maximum visual acuity in a patient, even with perfectly fitted glasses.

Other symptoms confirming the presence of the disease include: thinning of the corneal stroma, deposits of hemosiderin in the basal layer of the corneal epithelium (Fleischer's ring), as well as perforation of Bowman's membrane. These signs are easily identified during examination using a slit lamp. Special devices are also used in the diagnosis of keratoconus: retinoscope, keratometer. With their help, signs of an abnormal shape of the cornea are identified.

In particular, the ultrasound method and the pachymetry method are certainly useful, which are very important for confirming the diagnosis, because they can be used to identify the degree of thinning of the cornea in persons with suspected keratoconus. Particularly suitable for this purpose are devices from Bausch & Lomb and Orbscan, which combine the capabilities of different methods of diagnostic examinations, which makes it easier to identify the disease.

Our ophthalmology clinic offers its patients all the most effective and proven methods of treating keratoconus used in world ophthalmology. By contacting the Clinic of Dr. Shilova, you can be confident in the professionalism of the doctors and 100% German technologies for your vision!

Treatment of keratoconus

Today, medicine cannot yet offer patients with keratoconus convincingly effective medicines capable of preventing or curing the disease. However, its progress can be slowed down if you simply do not rub the sore eye.

If correction with glasses or soft contact lenses is ineffective, the patient may be offered conservative treatment of keratoconus with hard contact lenses or surgical treatment of the disease. Surgery for keratoconus is particularly diverse and includes the following methods: penetrating and layered keratoplasty, implantation of intrastromal rings, asymmetric radial keratotomy, epikeratophakia, collagen cross-linking of the cornea.

Keratoconus and contact lenses

Distortion of visual objects in the early stages of the disease can be corrected with glasses for minor myopia and astigmatism caused by keratoconus. As the disease progresses, the absolute choice of vision correction is the constant wearing of contact lenses. The selection of lenses is strictly individual, because there is no single design that is ideal for all types and stages of keratoconus.

Soft contact lenses . The use of such lenses is limited, because when covering the abnormal surface of the cornea, they take its shape. In this case, there is no space filled with tear fluid between the lens and the cornea, which reduces the efficiency of the refractive corneal surface.

Gas permeable rigid contact lenses. This is the main method of vision correction in this disease. They contribute to the correction of the abnormal shape of the cornea. Besides, hard lenses in conjunction with the tear fluid in the space between the lens and the corneal surface, they become the new refractive surface of the eye.

Double layer lenses . Consisting of two layers, combined lenses are used in particularly difficult cases: with intolerance to hard lenses, thinning of the apex of the cornea, epithelial erosion, central opacities of the cornea. Such an optical system includes a hard lens and a soft one adjacent to the surface of the eye.

Radial keratotomy

Radial keratotomy is one of the surgical techniques for treating myopia, developed by the outstanding Soviet ophthalmologist S. Fedorov . To get rid of keratoconus, one of its modifications is used - asymmetric radial keratotomy (ARK). This is a specific surgical procedure that involves making micro-incisions in the cornea to smooth out or enhance the irregularity of its shape. However, this operation is not widely used due to high risk complications and unstable results.

Crosslinking

A new method that stops the development of keratoconus is corneal collagen cross-linking (C3R/CCL/CXL). This procedure helps to increase the rigidity of the cornea, allowing it to further resist deformation.

Keratoconus weakens and thins the cornea, and irregular astigmatism develops. When crosslinking, non-toxic riboflavin (B2) is used, which plays the role of a photosensitizer and dosed irradiation with UV rays, which causes free radicals to appear inside the tissue. The effect is to strengthen the bonds of collagen microfibrils of the corneal tissue, which helps to increase its rigidity.

Crosslinking is a gentle and fairly simple procedure. It is performed under local drip anesthesia. During the operation, a layer of epithelium is removed from the central part of the cornea. Before this, a riboflavin solution is used to saturate the stroma, followed by UV irradiation. Irradiation is performed using a calibrated instrument for approximately thirty minutes. Postoperative period almost no different from that after PRK. The patient wears a protective lens and receives local drip treatment for at least three days to ensure rapid epithelization of the surgical wound.

In our clinic you can get advice and undergo treatment from world-class cornea specialists, Professor Tatyana Yurievna Shilova and the leading ophthalmologist in Germany - Doctor of Medicine, Professor Walter Secundo. By affordable prices and right in Moscow!

Intrastromal corneal rings

The method of implanting segments of special rings inside the cornea (keraring) has become the latest surgically correction of astigmatism caused by irregular keratoconus. The operation is a full-fledged alternative to corneal transplantation.

Today, 2 types of intracorneal rings are used: Intacs, with a hexagonal cross-section, and Ferrara Rings, with a triangular prism shape. Typically, the rings are implanted deep into the corneal stroma. Such operations are performed quickly and painlessly, under local anesthesia, on an outpatient basis.

For the procedure, a vacuum layer-by-layer dissector or femtosecond laser is used, with the help of which a special pocket for the rings is created. It is assumed that the effect of such rings is to create a buoyant pressure that flattens the top of the cone, making its shape more natural. Also, a large role in achieving the leveling effect belongs to the thickening of the overlying epithelium adjacent to the segments.

Corneal rings for keraring - Ferrara Rings and Intacs have many differences. So in the first case, the rings have a smaller radius of curvature and, when installed, there is less likelihood of aberrations occurring, which is explained by their prismatic shape. Ferrara Rings are smaller in size and this allows them to be placed closer to the corneal center, which provides greater effect. With their help, it is possible to correct myopia up to −12.0D, and this result is much better than that of Intacs rings. However, patients with larger pupil diameters may experience glare when installing Ferrara Rings. In this case, Intacs implantation is indicated.

The results of treatment with intrastromal rings are usually positive, with a significant reduction in the degree of astigmatism and improvement in visual acuity. Particularly good results are achieved with mild and middle degrees keratoconus.

Possible complications of the procedure include perforation of the anterior chamber, infection, aseptic keratitis, and postoperative ring expulsion. If necessary, the rings are easily removed, after which the cornea returns to its original state.

Corneal transplantation

Corneal transplant surgery is called keratoplasty. When it is performed, the patient's damaged corneal tissue is replaced with healthy donor tissue. This significantly improves vision and relieves pain in the affected eye. Keratoplasty is indicated for severe deformation of the cornea due to disease, infection, trauma, or inadequate pretreatment.

The operation may involve removing part of the clouded corneal tissue (layered keratoplasty) or all layers completely (penetrating keratoplasty) and replacing it with a suitable graft. For keratoconus, a corneal transplant is required in 10-20% of cases.

The success of keratoplasty, after which the patient gains good vision, is at least 90%, which is quite high rate. Restoration of vision after keratoplasty does not occur immediately. This often takes several weeks or months, very rare cases the process can take a year.

Most frequent risks operations are:

Transplant rejection. The process occurs due to the patient's immune system attacking a foreign element. Such cases are not at all uncommon and occur in every fifth person who has undergone a corneal transplant procedure. In most cases, after timely treatment, rejection can be avoided. The graft takes root and functions successfully. As treatment, steroid drugs are prescribed in drops, tablets, and sometimes in injections.
Transplant infection. The situation occurs when the sutures that hold the flap in place loosen or break and is extremely serious. If the infection is not treated, the transplanted graft may die, or in the worst case, the eye may be lost.

Glaucoma. Application steroid drugs after transplantation, can cause a persistent increase in IOP, which gradually damages the optic nerve.

Retinal disinsertion. After penetrating keratoplasty, this condition is observed only in 1% of cases. It can be easily treated surgically.

Our clinic has developed a unique proprietary method for treating keratoconus in the terminal stages, which allows not only to preserve your own cornea and stop the disease, but also to significantly improve your vision - sign up for a consultation with Professor Tatyana Yuryevna Shilova today!

197 02/13/2019 5 min.

Keratoconus refers to those diseases that are accompanied by deformations of the components eyeball, which leads to loss of vision or even the eyeball. As a rule, such changes rarely respond to conservative treatment and require surgical intervention. Therefore, it is especially important to register with an ophthalmologist at the very first symptoms of the disease and monitor the course and results of therapy.

Definition of disease

Keratoconus is a disease of the cornea of the eye, accompanied by its deformation. During the course and progression of the disease, it does not become inflamed, but becomes thinner and takes on the shape of a cone. IN severe forms and as a result, the patient is able to lose the previous quality of vision. This phenomenon is associated with increased moisture pressure inside the eye, which affects all layers of the membrane.

People aged twenty to forty years are at risk. Complete loss of vision () due only to the progression of keratoconus, as a rule, does not occur. In addition, the disease progresses slowly and is often accompanied by remissions. It can be in acute and chronic form.

The disease can be inherited, so if you have a predisposition, you must register with an ophthalmologist after reaching twenty years of age.

Kinds

The development of keratoconus can occur in stages:

In order to prevent transition to a new stage, treatment for keratoconus must begin immediately when the first symptoms occur.

Types of pathology are also divided according to the form of deformation:

Causes

At the moment, the exact causes of this pathology are not fully understood. However, the following prerequisites are reliably known:

Symptoms

Among the first signs of the disease, as a rule, pain and a sharp deterioration in vision are noted. However, the course of keratoconus is not limited to this. With it, a rapid increase can be observed, and as a result, tissue rupture. These signs are characteristic of the acute form of the disease. Chronic has the following symptoms:

If there are ruptures of the membranes and tissues, scars may remain when the edema is removed. To avoid this, you need to be prepared for swelling and avoid serious complications.

Possible complications

Complications of the disease are possible late stages, which suggest severe clouding and protrusion of the cornea. In this case, there is often a severe decrease in visual acuity, blurred images, permanent damage and tissue rupture. Edema can also be persistent and is often accompanied by painful sensations and profuse tearing.

The most severe degree of complication is the occurrence of dropsy, which can lead to loss of the eyeball.

Treatment

Diagnosing keratoconus in the early stages is quite difficult, but medical devices, examination and questioning of the patient can help. During the examination, the ophthalmologist needs to check and, as well as the possible presence of astigmatism. Based on the results of the examination, treatment is prescribed depending on the stage and type of the disease.

Ophthalmological examination

By medication

Treatment with medications can only be effective in the early stages of the disease. In this case, the following is prescribed:

Eye ointments are also used various injections. In some cases, it is possible to wear special glasses, contact or.

Surgically

Correction of deformity is possible at the fourth and fifth stages of keratoconus progression. With the help of surgery, the cornea is flattened by introducing artificial corneal rings into the tissue. At the same time, the possibility of ring rejection has an extremely low probability (less than one percent), and after the intervention the patient almost immediately feels an improvement and increase in visual acuity. Currently, two types of operations are used: through and interlayer.

Epikeratophakia is also used. It involves removing the top layer of the affected cornea and replacing it with donor tissue. With the help of radial keratomy, the deformity is eliminated by small incisions of the membrane, thermokeratoplasty - by applying point applications.

Laser thermokeratoplasty.

Only surgical intervention can completely restore vision in the final stages of pathology.

Folk remedies

To treat and relieve keratoconus, you can use traditional medicine recipes:

Lotions. For them you can use decoctions medicinal herbs: chamomile and sage. This product will help relieve irritation, redness and discomfort.
Echinacea tea(sold in pharmacies) and honey can increase the level of immunity.

Traditional methods cannot be used as alternative way treatment. They can only act as aids.

Prevention

In order to prevent the possible occurrence of pathology, it is necessary:

Protect your eyes from exposure to sunlight and other sources of ultraviolet radiation;
Do not touch your eyes with your hands;
Avoid traumatic situations;
Timely undergo professional therapy for diseases of the visual system;
Choosing the right contact lenses
Follow the basic rules of eye hygiene.

A preventive visit to an ophthalmologist at least once every six months would be useful in this situation.

Video

conclusions

Keratoconus is an extremely unpleasant disease, accompanied by external changes in the eye, deterioration in the quality of vision, swelling and pain. With progression, this anomaly can even lead to. However, with proper professional therapy, vision can be completely restored and the patient can return to his normal lifestyle. The most important thing is to start treatment on time and choose the right method.

Many doctors are confident that most people have a tendency to develop keratoconus from birth. True, the disease begins to progress much later. Most often, such corneal pathology occurs in adolescence and in people no older than 30 years. Moreover, up to a certain point this disease can be disguised as astigmatism or myopia. The disease is very dangerous because in advanced cases it can lead to corneal rupture and even loss of the eye.

Keratoconus: what is it?

This eye disease is a chronic, progressive process in which the cornea becomes thinner. This condition develops due to a weakening of the connection between the collagen fibers of its inner layers. As a result, under the influence of pressure inside the organ of vision, a change in the cornea occurs, which leads to the formation of astigmatism and myopia.

With severe deformation, the shape of the ocular cornea becomes cone-shaped. And later certain time, due to the progression of the disease, clouding and swelling of this membrane occurs, which further reduces vision.

This disease can begin to develop in adolescence, while the main signs of the disease may appear only at 20-30 years of age. The development of the disease in older people is extremely rare. In such patients, a similar illness occurs mainly after laser eye correction. Not every one of them knows what keratoconus is, so they seek help late.

Contact lenses and glasses for this disease do not help to completely get rid of vision problems. The disease can lead to complete blindness, and it remains with the person for life.

Keratoconus: degrees of disease

This disease can be primary or secondary, it all depends on the cause of its occurrence. Moreover, in 95% of cases, the deformation is bilateral, in other words, both eyes are subject to thinning of the cornea. Unilateral keratoconus occurs in only 5% of patients. Corneal deformation may be as follows:

Mastoid. The cone is increased to 5 mm, the change is located in the center.
Oval. The protrusion of the cornea is about 6 mm, the deformation is directed downward.
Globular. The size of the cone exceeds 6 mm, most of the cornea is covered by the disease.

Progression of keratoconus may take time for a long time(up to 15 years), while the stages of the disease will gradually increase. Detection of pathology is often delayed because accompanying symptoms she is very blurry. In other cases, the disease develops in spurts, with symptoms first appearing and then disappearing for a long period.

But the most complex form of the disease is considered to be corneal hydrocele - acute keratoconus of the eye. This degree of pathology is detected in 7% of patients. When it occurs, a rupture of the thinned cornea occurs, resulting in aqueous humor flows out and forms a cloudy spot on the organ of vision. After about 1.5 months, the process of scarring of the cornea occurs and the patient may experience temporary improvement, but the resulting opacities will interfere with good vision.

The described disease is also classified according to the degree of increase in symptoms. The entire period of the disease is divided into the following stages:

At an early stage, the curvature of the cornea is less than 45 diopters. Ophthalmologists record small morphological changes.
At the second stage, doctors discover myopia and astigmatism, which are difficult to correct with glasses.
Further, the deformation of the cornea is 45-52 diopters. With it, cracks in Descemet's membrane appear, through which moisture from the anterior chamber penetrates into the cornea, and the apex of the cone becomes cloudy. Points of opacification form on the cornea, and there is a possibility of developing acute keratoconus. A person sees practically nothing at night.
The curvature of the cornea reaches 52-62 diopters, clouding covers most of it. The patient sees poorly during the day, his visual acuity is greatly reduced, and even more spots of clouding appear. Visually, you can notice a convexity of the cornea.
In this severe form of the disease, the cone-shaped deformation of the cornea exceeds 62 diopters. At this stage, the cornea becomes completely cloudy, and vision is greatly reduced. There is a danger of its rupture, which can lead to loss of the eye. Therefore, immediate surgical intervention is required.

Why does the disease occur?

What it is - keratoconus, and how it develops, every person needs to know, this is the only way to avoid complications. True, the pathology in question has not yet been fully studied. Many doctors believe that keratoconus is a chronic degenerative disease. Its main causes include hereditary factors, structural features of the cornea and negative environmental influences.

With keratoconus, the Bowman's membrane is destroyed in the cornea. This pathological process causes the cornea to have uneven thickness, with areas of clouding and thinning. As a result, it is stretched and deformed under the influence of pressure inside the eye, which leads to a deterioration in visual acuity.

There are several hypotheses that explain the reasons contributing to the development of this disease. For example, endocrine diseases. In patients with such disorders, the activity of protease inhibitors in the tear fluid and cornea is reduced. At the same time, the activity of proteases, enzymes that destroy collagen, increases. Reducing the amount of protease inhibitors leads to the fact that they cannot resist damage to the collagen ligaments in the transparent layer of the cornea.

In addition, the progression of the disease is facilitated by the accumulation of oxidants and free radicals in the cornea, due to a decrease in the activity of aldehyde dehydrogenase. With an increase in the number of markers of oxidative stress, keratoconus can also develop.

Heredity is also the cause of the formation of this disease. According to some scientists, corneal pathologies are transmitted at the genetic level. Such diseases are inherited in an autosomal dominant manner. True, they have not yet been able to find the gene in which the disorder appears, however, according to statistics, in patients suffering from Down syndrome, thinning of the cornea occurs much more often than in healthy people.

Experts also suggest that keratoconus is based on a genetically or hereditarily determined feature of the body, which is expressed in a decrease in activity, absence, or deficiency of one or another enzyme. Hereditary fermentopathy does not manifest itself in any way until certain point. A similar process can be triggered by a sharp deterioration in the functioning of the immune system, changes in hormonal levels, or a serious illness - all this leads to changes in the cornea.

The reasons for the development of keratoconus also include immunological ones. According to this hypothesis, bioactive substances are formed in the cornea, under the influence of which the regeneration processes of the eye epithelium are disrupted. Such disorders lead after some time to thinning of the cornea. Along with keratoconus, the patient may experience the following problems: atopic dermatitis, eczema, allergic reaction, hay fever and bronchial asthma.

The researchers also noted that among patients suffering from the hepatitis B virus, there are many who have thinning of the cornea.

Keratoconus often appears due to the constant use of incorrectly selected contact lenses. This disease can also develop after surgery, for example, laser vision correction.

Some experts associate the occurrence of keratoconus with psychological disorders: psychotrauma, stress or strong negative experiences. But this theory, like many others, is just speculation by scientists.

Signs of a thinning cornea

When understanding what keratoconus is, you need to note its signs. Thus, there is a change in the shape of the cornea and its clouding. It comes down to astigmatism with a tendency to constantly change axes as the disease progresses and visual acuity deteriorates. Myopia with keratoconus develops gradually, and is also accompanied by diplopia (double vision).

Vision in keratoconus deteriorates gradually. Patients have to change glasses all the time due to the increase in the number of diopters. Often such vision correction is unfavorably tolerated because it does not produce positive results. And sometimes the patient does not have time to purchase new glasses because the disease progresses too quickly. In this case, it is necessary to treat keratoconus.

Reviews left by experts make it clear that in advanced cases, contact lenses also do not help, since they cannot fit tightly to the cornea of the eye.

Quite often, with keratoconus, patients begin to see double while watching TV or reading. In addition, the following symptoms may be present:

itching and irritation of the organs of vision;
photophobia;
rapid eye fatigue;
burning sensation.

If at the first stage of the pathology only deterioration occurs twilight vision, then as it progresses, even in daylight, a person ceases to distinguish objects. On last stages disease, bulging of the cornea becomes visually noticeable.

As a rule, all stages of keratoconus progression take about 10-15 years. In most patients, the disease can stop its development, entering a state of long-term remission. But in 5% of people, on the contrary, the disease quickly becomes acute. At this stage, Descemet's membrane ruptures and intraocular fluid leaks out.

In acute keratoconus, a person experiences discomfort, severe discomfort and corneal edema. After 2 weeks, the corneal tissue becomes scarred, which may lead to a temporary improvement in visual acuity.

Diagnostic procedures for keratoconus

As a rule, in the early stages of the development of this disease, the patient complains of a sharp deterioration in vision. In the process of progression of the pathology during a physical examination, the specialist detects clouding of the Bowman's membrane and protrusion of the cornea. Diagnosis of keratoconus also involves performing procedures such as:

Skiascopy. It is performed to determine the ability of the pupil to refract light.
Refractometry. This examination can detect astigmatism and myopia.
Pachymetry. Necessary to determine uneven thickness of the cornea.
Biomicroscopy of the organ of vision. This study helps to detect cracks in the membrane, growths of nerve endings in the center of the cornea, clouding, changes in epithelial cells and stromal degeneration.
Ophthalmoscopy. Such an examination is carried out to evaluate the vessels of the fundus, the disc optic nerve and retina.

If there are any doubts, then to clarify the diagnosis, you can contact the intersectoral scientific and technical complex "Eye Microsurgery" named after. acad. S. N. Fedorov to conduct computer keratometry. This research method is used for precise definition the degree of astigmatism, the refractive power of the cornea and the thickness of the eye membrane. Can also be assigned CT scan to determine the size of the cone-shaped protrusion.

Unfortunately, in many cases, the detection of keratoconus at the earliest stages is difficult. Therefore, quite often, with such a disease, patients are sent to the MNTK named after. Fedorov.

Therapeutic methods

The ophthalmologist prescribes treatment procedures depending on the degree of the disease. At stages 1-2 of keratoconus, patients are recommended to wear glasses and soft contact lenses for vision correction, the price of which is not too high. These optical devices help correct astigmatism and non-critical myopia.

However, conservative therapy is not able to completely eliminate the deformation of the cornea. Such treatment is resorted to to increase its tone, reduce irritation and discomfort. Experts usually recommend using special drops for keratoconus: “Taufon”, “Oftan-katachrome”, “Floxal”, “Quinax”. In addition, they recommend taking anti-inflammatory drugs such as Diklof and Naklof.

For this disease, doctors also prescribe:

applying an eye patch using sodium chloride ointment;
"Emoxipin" in injections;
immunostimulants and vitamin complexes;
hormonal drugs (“Maxidex”);
sea buckthorn oil as eye drops.

Treatment for keratoconus involves taking these medications to protect the cornea from external influences, activation of regenerative function and elimination of irritation. Additionally, they resort to physiotherapeutic methods that give good results: phonophoresis and magnetic therapy.

When the cornea becomes thinner, “Sidorenko glasses” are often worn. This ophthalmic device is used for vacuum massage around eyes.

Corneal crosslinking

Such an operation in our country can be performed at Fedorov’s MNTK, they do it qualified specialists. This effective and modern procedure consists of photopolymerization of stromal fibers, which release oxygen under the influence of ultraviolet light and riboflavin. As a result of this, they begin to form special bonds in collagen fibers, which improves their resistance to various mechanical factors and strengthens the cornea.

Riboflavin (in other words, vitamin B2) is an essential substance for redox processes. It is needed for the production of antibodies and red blood cells that maintain the health of the appearance of nails, skin, hair and the entire body as a whole.

The crosslinking procedure is performed under local anesthesia using special drops. Doctors use surgical instruments to remove upper layer corneal epithelium and instill riboflavin onto the freed area. Then the treated area is exposed to ultraviolet light. The next stage of the operation is the application of an antibiotic, on top of which a special contact lens. This optical device will have to be worn for about 4 days after surgery.

Elimination of the disease by surgery

Surgical treatment of keratoconus is not prescribed for all patients. Only after examining the patient and receiving all tests can a specialist refer him for medical reasons for surgery.

When the cornea becomes thin, penetrating keratoplasty is performed. But they resort to surgical intervention extreme cases. This treatment method involves transplanting a donor cornea to a patient who has keratoconus.

An operation to implant ring-shaped corneal intrastromal segments is also performed for this eye disease. During the procedure, thin arcs made of polymer materials are implanted into the tissue of the cornea. These devices exert pressure on the cornea, balancing the intraocular pressure, which is directed outward. As a result, the shape of the cornea is corrected.

But it should be remembered that laser vision correction is contraindicated for keratoconus. The price for this procedure is in the range of 25-30 thousand rubles per eye.

Elimination of pathology using non-traditional methods

It is best to resort to such treatment in the early stages of the disease in order to stop the progression of the disease. More folk recipes help during rehabilitation period. However, you need to know that to straighten the cornea in unconventional ways Treatment is impossible, they only help slow down the pathological process. Without medical care there is no way to get rid of this disease.

For keratoconus, compresses made from chamomile and sage flowers will help relieve itching and tension in the eyes. To strengthen the immune system, you should take a rosehip decoction. To improve vision, it is recommended to drink blueberry or carrot juice every day.

How to avoid developing keratoconus?

In most cases, the described disease progresses slowly. Sometimes its development may stop altogether at any stage. The later in age corneal keratoconus appeared, the better prognosis and its flow is slower.

And in order to eliminate the likelihood of the occurrence of this eye pathology, it is necessary to promptly treat the disorders that contribute to its occurrence - inflammatory, endocrine, immune, allergic and others.