Management of Keratoconus: Recent Trends

Abstract

Keratoconus (KC) is a bilateral, progressive disease characterised by corneal thinning, ectasia, variable degree of irregular astigmatism and resultant mild to severe reduction in visual acuity. Multiple advances in corneal imaging and topographic mapping have led to a better understanding of the disease and its progression. Traditionally, use of spectacles and rigid contact lenses has been the primary mode of treatment in early KC, while keratoplasty has been the treatment of choice in advanced cases. However, development of an array of therapeutic options over the last decade has revolutionized the approach to this disease. The preferred treatment for progressive KC has shown a paradigm shift from contact lens fitting for as long as tolerated, followed by Penetrating Keratoplasty (PK) or Deep Anterior Lamellar Keratoplasty (DALK), to Ultraviolet-A (UV-A) induced collagen cross-linking (CXL) to stabilize corneal ectasia in the long term. Recently, use of Intrastromal Corneal Ring Segments (ICRS), Phakic IOLs, application of excimer laser and use of combination techniques have all made significant contribution in providing options for effective management of different stages of this disease. Bowman layer (BL) transplantation is a new technique that has recently been introduced as an alternative to PK/ DALK in eyes with advanced KC, unsuitable for either UV-CXL or ICRS. By means of this article, we aim to provide a summary of these recent trends in therapeutic options for the optimal management of keratoconus.