Keratoconus is one of the mostly seen eye degenerations, which is characterized by a non inflammatory corneal stromal thinning. It is more present in man than in women, and in some ethnic groups compared others.
The exact cause of keratoconus is still unknown, but it can be connected with poor enzyme activity within the cornea. There are also some proofs of inheritance, where keratoconus is more seen in children whose ancestors also had this degeneration. Progression of keratoconus is much faster in patients with Down’s syndrome. The disease itself usually affects both eyes, but it is more expressed in one eye than the other. It usually progresses in adolescence.
Prof. dr Nikica Gabrić, dr med.
Mr sc. Bojan Kozomara dr med.
Ernesta Potkonjak, dr med.
Nebojša Đogatović, dr med.
Sanja Savičić, dr med.
Ana Aničić, dr med.
Miloš Milićević, dr med.
Vladimir Račić, dr med.
Borjana Solomun, dr med.
Dajana Abdulaj, dr med.
Tamara Bojanić Barić, dr med
Here you can find frequently asked questions by our patients. If there are things that we did not answered for you, please don’t hesitate to contact us.
Major symptom of keratoconus is one-sided decrease of vision due to progressive myopia and astigmatism that becomes irregular. Crucial signs is the central and paracentral thinning of the stromal corneal tissue (it becomes conical).
Treatment of mild and moderate cases of keratoconus is done by the RPG contact lens wear. For progressive phases of the disease, corneal collagen crosslinking (CXL) is advised. Patients with mild to moderate keratoconus who tolerate well their RPG lenses are generally happy with their vision, while those who have progressive keratoconus and who cannot wear contact lenses are mostly advised to undertake CXL, or in the late stage corneal transplantation. The best diagnostic techniques for a proper follow up of keratoconus are anterior segment OCT and Oculus Pentacam II.
Crosslinking is a procedure by which the thinned stromal corneal tissue in keratoconus is strengthened and progression of keratoconus is slowed down. The emphasis is on the “slowing down”, because this procedure is used less than 20 years and there are not enough time distance and medical proofs that it is successful in all patients. According to the available data, out of 5 patients that undergo crosslinking, one ends up on the corneal transplantation surgery.
Crosslinking is recommended to all patients whose corneal thickness is not less than 400 microns, who have no corneal scars, whose keratometry is not more than 58 diopters, and who have best corrected visual acuity of 90% or less. Patients who have other eye diseases, as well as female patients who are pregnant, are not good candidates for this procedure.
Duration of the procedure is about two hours. It is done in topical anesthesia and it is completely painless. Corneal epithelium is stripped off by a blunt instrument and underlying tissue is treated with high dosage of vitamin B2 contained in the thick liquid called Riboflavin. Vitamin B2 is applied to the cornea for over 20-30 minutes. Riboflavin has a multiple purpose: it strengthens the cornea and protects deeper eye segments of the UV light used in crosslinking. At the end of the vitamin B2 application, cornea is treated with UV lamp throughout the next half an hour. The lamp turns off by itself every 5 minutes when vitamin B2 is applied again. At the end of the treatment, soft contact lens is applied, which stays on the eye for 5-7 days. Patient receives local therapy of antibiotics and artificial tears for the next two months. For the first postoperative days, patient can feel slight pain.
The procedure described above is a part of the “Dresden protocol”. Real treatment success after crosslinking is accessed after 6-12 months, and in children after 24 months. After crosslinking, the patient can continue with their contact lens wear.