It is important to remember that there is no surgery to “cure” keratoconus. In other words, surgery does not free patients from the need for corrective lenses (and typically rigid contact lenses). There are three surgeries available that serve a purpose certain individuals with keratoconus.
Corneal Cross Linking
This breakthrough surgery has been a game-changer in keratoconus management since it was FDA approved in late 2017. Corneal Collagen Cross Linking (CXL, C3R) is a procedure that stabilizes the corneal shape, preventing further progression of keratoconus or other corneal ectasias. The procedure involves bathing the cornea in riboflavin and then exposing it to UV light. This causes a reaction that increasing the cross-linking of collagen fibers in the cornea, therefore increasing corneal rigidity and preventing further steeping of the cornea. It is important to note that this procedure does not get rid of the optical effects of keratoconus, instead it simply stops the progression in an effort to maintain best-corrected visual acuity and prevent corneal scarring or the need for corneal transplantation. This procedure combined with scleral lens fitting has become an extremely effective management technique for those with keratoconus, pellucid marginal degeneration and post-refractive surgery ectasia.
Intrastromal Corneal Ring Segments
These corneal implants were initially developed to help stop the progression of keratoconus, but studies have since found that they are not effective in doing so. They are still used by some specialists as a way to flatten the cone in hopes of making rigid contact lens fitting easier. With the advent of cross-linking and scleral lenses, this procedure has been made largely obsolete.
A corneal transplant is a last-case scenario for any corneal disease. Most transplant patients still need a rigid lens (like a scleral lens) in order to see adequately, and chronic steroids are typically needed to prevent rejection. That said, if a cornea becomes too steep or too scarred to be functionally corrected with scleral lenses, a corneal transplant can be a great option to restore sight.
Andrew Biondo, OD, FSLS is the Primary Medical Director at Kirkwood Eye Associates in Kirkwood, MO. Serving the greater St. Louis area, Dr. Biondo has 12 years of experience as an eye care provider, health educator & consultant to the specialty contact lens industry. His special interests include contact lenses, dry eye disease, glaucoma, macular degeneration, laser eye surgery & preventive vision care.