Current review and a simplified "five-point management algorithm" for keratoconus

• Published in: Indian journal of ophthalmology Vol. 63; no. 1; pp. 46 - 53
• Main Authors: Shetty, Rohit, Kaweri, Luci, Pahuja, Natasha, Nagaraja, Harsha, Wadia, Kareeshma, Jayadev, Chaitra, Nuijts, Rudy, Arora, Vishal
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer - Medknow Publications 01.01.2015; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Age; Algorithm; Algorithms; Antioxidant supplementation; Astigmatism; Bevacizumab; Care and treatment; Choroidal metastases; Chronic glaucoma patients; Contact Lenses; Cornea - pathology; Corneal thickness; Corneal Topography; Corneal Transplantation; cross-linking; Cup to disc ratio; Cytokines; Development and progression; diabetes mellitus; diabetic retinopathy; disc area; Disease Management; economic burden; Eye diseases; Eyeglasses; Family medical history; free oxygen radicals test; Fundus examination; glaucoma probability score; Global Health; halogen light; Health aspects; Humans; In vivo confocal microscopy; Incidence; indirect ophthalmoscope; Intacs; intravitreal bevacizumab; Keratoconus; Keratoconus - diagnosis; Keratoconus - epidemiology; Keratoconus - therapy; keratocyte density; light emitting diode; macular edema; menstrual cycle; moorfields regression analysis; nonproliferative diabetic retinopathy; normogram; Ophthalmic; optical coherence tomography; pachymetry; photo-stress test; pigment epithelium-derived factor; prostaglandin analogues; reactive oxygen species; refractive surgery; refractory; Rehabilitation; retinal vein occlusion; socioeconomic profile; transpupillary thermotherapy; triamcinolone acetonide; vascular endothelial growth factor; India; keratoconus; cross-linking; Intacs; Algorithm; normogram
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/0301-4738.151468

Keratoconus is a slowly progressive, noninflammatory ectatic corneal disease characterized by changes in corneal collagen structure and organization. Though the etiology remains unknown, novel techniques are continuously emerging for the diagnosis and management of the disease. Demographical parameters are known to affect the rate of progression of the disease. Common methods of vision correction for keratoconus range from spectacles and rigid gas-permeable contact lenses to other specialized lenses such as piggyback, Rose-K or Boston scleral lenses. Corneal collagen cross-linking is effective in stabilizing the progression of the disease. Intra-corneal ring segments can improve vision by flattening the cornea in patients with mild to moderate keratoconus. Topography-guided custom ablation treatment betters the quality of vision by correcting the refractive error and improving the contact lens fit. In advanced keratoconus with corneal scarring, lamellar or full thickness penetrating keratoplasty will be the treatment of choice. With such a wide spectrum of alternatives available, it is necessary to choose the best possible treatment option for each patient. Based on a brief review of the literature and our own studies we have designed a five-point management algorithm for the treatment of keratoconus.