Corneal crosslinking - the appropriate choice of the keratoconus treatment
|Year of publication
|MU Faculty or unit
|Keratoconus is an ectatic progressive degenerative disorder of the eye in which structural changes within the cornea cause it to get thin and change to a more conical shape. Usually it occurs in the central or paracentral area associated with the emergence of myopia and irregular astigmatism. The onset is around puberty with slow progression thereafter until the third or fourth decade of life. Almost all cases are bilateral. The basis of diagnosis is the detailed eye examination. Corneal topographer is the most sensitive method of early keratoconus detection and of the progression monitoring. In the advanced stages, doctor usually detects these syptoms of keratoconus: oil droplet reflex, Fleischer ring, Vogt lines, Munson sign. Acute worsening of the condition is called acute hydrops. It is caused by a rupture in the Descemet´s membrane that allows an aqueous influx into the cornea and deterioration of visual acuity to the movement. In the early stages of keratoconus, visual acuity may be corrected by spectacles, higher stages can be corrected well with the help of hard contact lenses only as they correct irregular astigmatism better. Previously the only option of treatment was corneal transplantation, it is nowadays possible to implant the intrastromal rings in order to reduce high myopia and to partially stabilize keratoconus. The corneal crosslinking is then just keratoconus causal treatment, which stops the progression of the disease. CXL is a photodynamic therapy involving a one-time application of riboflavin solution into the eye that is activated by illumination with UV-A light (365nm) for approximately 30 minutes. It initiates cellular crosslinking of corneal collagen. It leads to a decline to a complete discontuniation of the cornea thinning. The corneal epithelial layer is generally removed to increase the riboflavin penetration into the stroma, but in our department we perform transepithelial technique of the cornea collagen crosslinking.