Minimally Invasive Keratoconus Surgery

Keratoconus surgery procedures

Techniques to treat keratocons and improve vision acuity include the use of glasses, contact lenses, intrastromal corneal rings implants (INTACS), corneal cross linking with riboflavin, laser treatment to remove scars or nodules on the keratoconus apex, and, in the most serious cases, lamellar corneal transplant (perforating or full-depth).

In case of keratoconus, corneal topography is essential to decide which is the best treatment.Contact lenses and keratoconus: to start off, it is important to say that contact lenses do not slow down the progression of the keratoconus.

Contact lenses cannot slow down keratoconus progression: they only help to see better. Several kind exist: soft, rigid, semirigid, with variable geometry. A contactologist together with the ophthalmologist will advice you on the best kind of contact lens for your keratoconus situation.

To slow down keratoconus progression, it is best to avoid rubbing the eyes and, if it is in its initial phase, cross linking could be useful. Cross linking treatment is meant to make the cornea stronger, making it more difficult for it to change shape. It can be performed only on selected patients. There are several keratoconus surgical techniques.


Keratoconus laser surgery is suggested in case of nodules or scars on the keratoconus apex. Keratoconus laser treatment can be of great help because it flattens and regularise the conus along with vision improvement and/or higher contact lenses tolerance.

Minimally invasive keratoconus surgery consists in the intrastromal rings or INTACS. This rings made of a plastic material are inserted in the peripheral cornea, flattening and regularising the keratoconus center. Intrastromal rings can improve vision and contact lenses tolerance in case of keratoconus.
The advantage of this kind of keratoconus surgery is its total reversibility. Rings, if not tolerated, can be easily removed, going back to how things were before surgery.
When keratoconus is in a more advanced phase, or contact lenses are not tolerated at all, the best solution is the anterior lamellar corneal transplant, also called DALK (Deep Anterior Lamellar Keratoplasty), that can be performed with several techniques.
Anyway, keratoconus treatment centers that can perform this kind of transplant are just a few because this is a complex procedure. We suggest to reach for keratoconus specialized centers that can perform this technique.

During the anterior lamellar transplant DALK, the damaged portion of the cornea is removed, leaving the healthy endothelium.

The main advantage is a faster convalescence and less complications. Dr. Badalà performs this kind of corneal transplant in Milan and Catania. In case of an initial conus or a conus that stopped at the initial phase, it can be possible to achieve a good vision quality even with glasses; in more serious cases, usually contact lenses have a good effect because they flatten corneal irregularities, but they cannot slow down the progression of the disease. During the initial phase, cross linking is important to slow down keratoconus progression. The next phase consists in laser surgery or intrastromal rings before and corneal transplant in a more advanced phase.

Keratoconus contact lenses

Corneas affected by keratoconus can be significantly different: every keratoconus differs from the others; there are also differences in perception from patient to patient.

This is why most manifacturers produce a large variety of contact lensens created for keratoconus: permeable gasses with different support geometries, with high oxygen passage, soft with thickness, hybrids like the Janus (permeable gasses in the central part and soft in the peripheral parts). There are also hybrid applications available (piggyback): a soft contact lens placed on the cornea and a permeable gas on top.
Hybrid solutions can be used when the goal is to improve comfort and centering the lenses. Lenses age and deteriorate. They have to be replaced: the moment to do so depends on the lens kind, but not after more than two years. If the keratoconus changed overtime, this substitution phase is ideal to change the lenses parameters, adapting it to the new corneal topography. It rarely happens that the lenses have to be replaced after just a few months because of a fast keratoconus variation.

Contact lenses and keratoconus: the first thing to say is that they cannot slow down the disease progression. Contact lenses cannot slow down keratoconus progression: they can only help to see better.

Corneal transplant for keratoconus: lamellar or perforating?

In case of keratoconus, corneal transplant is suggested when all of the other techniques failed. Lamellar corneal transplant helps for a quick vision recovery, has a lower rejection risk and a shorter post-op therapy, but it is far more complex than perforating transplant and in case of a very serious keratoconus may not be an option.

What are the latest news in keratoconus surgery?

There are several solutions when speaking of keratoconus surgery: intrastromal corneal rings (INTACTS), corneal cross linking with riboflavin, laser to remove scars or nodules in the keratoconus apex and, in the most serious cases, lamellar corneal transplant o full-depth perforating corneal transplant.
The minimally invasive keratoconus surgery consists in the intrastromal rings or INTACS.

This rings made of a plastic material are placed in the peripheral portion of the cornea and flatten and regularize the central part of the keratoconus. Intrastromal rings can improve vision and/or contact lenses tolerance in case of keratoconus. The main innovation in keratoconus treatment is the anterior lamellar corneal transplant, also called DALK (Deep Anterior Lamellar Keratoplasty). that can be performed with several techniques. The most successful one, as several american authors say, is the big bubble technique.

Which are the best keratoconus treatment centers?

There are several centers that can treat keratoconus in Italy. It is best to reach for a center that can perform all the different keratoconus treatment techniques. All the options complete one another.

Keratoconus treatment centers that can perform the DALK anterior lamellar transplant are only a few becaus of the complexity of the procedure, that has the advantage of a short post-op and less complications. The best thing to do is to ask for advice to the keratoconus sick patients association or to specialized centers to know which is the nearest specialist: early diagnosis and prompt treatment are the key to a good result.
Dr. Badalà performs this kind of corneal transplant and all the other techniques for keratoconus treatment in Milan and Catania, using tissues coming from the Eye Bank of Mestre.

 

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