What Is Keratoconus?

The normal and natural shape of the cornea is spherical because the cornea consists of several transparent layers that allow the passage of light rays into the eye and translate them into a visible image. However, in the case of keratoconus, there is thinning in the central region of the cornea through which the light ray passes, leading to a slight protrusion or what is called corneal ectasia due to a decrease in its thickness. This, in turn, results in the condition known as keratoconus, where the quality of vision and visual acuity deteriorates, and the patient experiences various complications and side effects, which will be mentioned later. We will also discuss the types of corneal transplantation procedures.

What Are the Symptoms of Keratoconus?

There are many signs and indicators that warn you of keratoconus. They alert you to the need to consult a doctor to ensure the safety of your eyes and their health. Some of these signs and symptoms include:

1. Blurred and distorted vision.
2. Difficulty in seeing near and distant objects.
3. Inability to drive at night.
4. Intolerance to bright and glaring light.
5. Chronic headaches.

One of the most important symptoms of keratoconus in children is:

Frequent need to change prescription glasses very frequently.

Complications of Neglecting Keratoconus:

Delaying treatment can lead to the appearance of undesirable symptoms and consequences that the patient can do without. If the patient undergoes the surgery early, these complications can be avoided, including:

1. Noticeable swelling of the cornea.
2. Rapid and surprising deterioration in visual acuity.
3. Injury to the inner lining of the cornea.
4. Observing halos in the patient’s field of vision.
5. Developing corneal ulcers and scars, which are the most dangerous stages of keratoconus that cause irreversible damage.

When Should Corneal Transplantation Be Done?

There are exceptional cases and special circumstances in which the patient needs surgical intervention as soon as possible. Delaying treatment for a long period may ultimately result in partial or complete vision loss. Emergency cases that require immediate surgical intervention include:

1. Patients whose keratoconus has progressed to the point of developing serious ulcers and lesions.
2. Patients who have undergone previous eye surgeries that were unsuccessful due to the surgeon’s incompetence or other factors related to the patient’s condition.
3. Patients with genetic diseases, such as in the case of Fuchs’ dystrophy.
4. Patients who have suffered corneal swelling and edema due to neglected treatment for extended periods.

What Is the Treatment for Keratoconus?

There are several old and modern treatment methods adopted for keratoconus, each with its advantages and characteristics, but all share a common goal: to halt the deterioration of keratoconus and restore normal vision to the patient. Among these treatments are:

1. Prescription Glasses:

In a mechanism similar to how prescription contact lenses are used, prescription glasses work to correct vision problems and restore the ability to see with the best possible quality. They are suitable for cases of mild to moderate keratoconus.

2. Corneal Ring Implantation:

This is a recently widespread procedure that has achieved significant success rates. It involves the implantation of rings into the cornea to correct its topographical shape and smooth its irregular surface. It is suitable for patients with moderate keratoconus.

3. Keratoconus Stabilization Procedure:

This procedure can be either therapeutic or supportive. It may help in permanently correcting vision or serve as a subsequent procedure to stabilize the cornea and prevent its deterioration. In this procedure, ultraviolet rays are directed onto the cornea, and riboflavin is applied to enhance collagen bonds within the cornea, thus stabilizing it. It is suitable for early-stage keratoconus.

4. Surface Laser Ablation for Keratoconus:

This technique can be applied to treat keratoconus under specific conditions, primarily requiring the expertise of a highly skilled surgeon and achieving the required corneal thickness. It uses laser rays to correct corneal irregularities and abnormalities and can be combined with corneal stabilization procedures.

These treatment options provide hope and solutions for keratoconus patients, with the choice of treatment depending on the individual’s condition and their ophthalmologist’s recommendations.

Corneal Transplantation

Corneal transplantation is the final therapeutic solution that many eye doctors resort to when all other treatment options have been exhausted. It is considered a highly reliable, safe, and successful treatment in about 99% of cases. There are several types of corneal transplantation, including:

1. Full Corneal Transplantation:

In this procedure, all layers of the cornea are replaced with healthy artificial ones taken from a recently deceased donor. This procedure is only performed in cases where the cornea is severely damaged, with extensive ulcers or severe external injuries. The recovery period can take several months because the surgeon uses surgical grafts to secure the new cornea, which extends the healing process.

2. Lamellar Corneal Transplantation:

In this type, only some layers of the cornea are replaced, specifically the posterior layers located deep within the cornea. It is often used in cases of genetic diseases, such as in patients with Fuchs’ endothelial dystrophy. There are two subtypes of lamellar corneal transplantation:

• Type 1: Deep Anterior Lamellar Keratoplasty (DALK) In this method, Descemet’s membrane and the endothelial layer of the cornea are replaced without relying on the use of the recipient’s stroma, as the corneal tissues are fragile and thin. This procedure is known for its relatively short recovery period and rapid results.
• Type 2: Deep Anterior Lamellar Keratoplasty with Descemet’s Stripping (DALK-DSAEK) In this procedure, Descemet’s membrane is removed along with the stroma’s anterior layers and replaced with healthy membranes. The surgeon often relies on Descemet’s Stripping to facilitate the transplantation process.

3. Deep Anterior Lamellar Keratoplasty (DALK):

   In this case, both the anterior and intermediate layers of the cornea are replaced with new layers taken from a recently deceased donor. This is achieved by directing an air stream toward the eye’s cornea at a specific angle, separating the corneal layers and making it easier to manage the transplanted tissues. Although this procedure yields excellent results, there is a potential risk of rejection.

Prior to Corneal Transplantation:

Certain precautions and instructions must be followed in the days leading up to the procedure to ensure its success, ease, and safety. These necessary measures include:

1. Visiting the doctor shortly before the surgery to conduct a comprehensive eye examination and confirm the stability of the eye’s condition.
2. Not neglecting the laboratory tests requested by the eye doctor, as they help prevent complications during the surgery, such as bleeding or clotting disorders.

3. Adhering to the medications prescribed by the doctor regularly and following the dosing schedule without any deviations. Some medications, such as diuretics or anticoagulants, may need to be temporarily discontinued.

What are the most important post-corneal transplant tips?

If you are planning to undergo corneal transplant surgery, you will be facing a period that requires extra attention and care for your health to avoid any unwanted complications or damages to the surgery. Therefore, we advise you to consider the following:

1. Do not neglect the eye drops prescribed by your eye doctor and make sure to use them correctly to prevent eye infections and inflammation.
2. Avoid strenuous physical exercises that could negatively impact the transplanted cornea area.
3. Do not rub or apply pressure to your eyes and avoid itching them.
4. Wear protective eye shields before sleeping to prevent accidental eye injury.

5. Stay away from dusty or polluted environments to avoid eye infections, as the eyes are highly sensitive during this period.