Keratoconus surgery can be performed relatively easily and with very good results given that the diagnosis is done on time

Keratoconus can be diagnosed by a routine examination

During this routine examination the ophthalmologist, among others, will examine the cornea of the patient and will measure its curvature. This kind of examination helps in the diagnosis by showing if there is any pathological change in its shape. The ophthalmologist can also map the surface of the cornea using specialized equipment and tests which will offer detailed information showing the condition of the surface of the cornea.


How is keratoconus treated?

The treatment of keratoconus depends on the symptoms. When the symptoms are mild, then the vision can be corrected even with prescription glasses and later, as the disease is progressing, with hard contact lenses (keratoconic contact lenses).


Other ways your eye doctor may need to treat the keratoconus are as follows :


1. Corneal Crosslinking (CXL)

In this case, of keratoconus surgery special ultraviolet (UV) light and appropriate eye drops (riboflavin - Vitamin B2) are used to strengthen the cornea. This procedure helps to flatten and harden the cornea by preventing further progression of keratoconus as clinical trials have shown that this type of keratoconus surgery enhances the micro-architecture and internal structure of the cornea.

The goal of the keratoconus surgery corneal crosslinking (CXL) treatment is to stop the progressive and irregular changes in the shape of the cornea, known as ectasia. Typically, these changes, which include thinning and increased corneal curvature, often lead to an increase and frequent change in the diopters of myopia and astigmatism.

Corneal Crosslinking (CXL) refers to the ability of fibrils to form strong chemical bonds with adjacent fibrils. In the cornea, its crosslinking can also occur naturally, through aging as the years go by, and it is believed that this why, in most cases, keratoconus progresses faster in adolescence or early adulthood but tends to stabilize in patients after middle age.

The bases for the currently applied keratoconus surgery with corneal crosslinking (CXL) techniques were developed in Europe by researchers at the University of Dresden in the late 1990s. UV light is used to photopolymerize stratified corneal fibers in combination with riboflavin which acts a photosensitizing substance. There are many studies that have shown that the use of keratoconus surgery with corneal crosslinking (CXL) does not cause any damage to the endothelium, given that all the safety standards that have been set are met (e.g. maintaining proper radiation, preoperative corneal thickness, etc.).


Surgical technique

Keratoconus surgery with corneal crosslinking (CXL) can be performed in One Day Clinics (O.D.C.) and lasts up to 30 minutes (most of the time less).

The primary goal of the first stage of the corneal crosslinking (CXL) treatment is to allow the diffusion of riboflavin into the cornea. At this stage there are many variations in the techniques used to achieve successful diffusion of the riboflavin, but they all involve either the removal or the disruption of the epithelial layer of the cornea. In all cases, the patient first receives anesthetic drops, and in some cases the ophthalmologist may also give preoperative and antibiotics. After the removal or the disruption of the epithelium, drops of riboflavin 0.1% are administered at intervals of 1-5 minutes for 10-30 minutes (depending on the protocol followed each time by the treating ophthalmologist).

After adequate absorption of riboflavin, ultraviolet light (UV with wavelength typically 365-370nm) is used at a short distance (1-5cm) from the top of the cornea (to focus properly) for 30 minutes at most (depending on the protocol followed each time by the treating ophthalmologist).

At the end of the corneal crosslinking (CXL) treatment, antibiotic drops are applied, and a protective contact lens is typically placed. The patient receives antibiotic drops 3-4 times a day for postoperative use (practically until the epithelium regenerates and the contact lens is removed).

Today, the ophthalmic community internationally favors the keratoconus surgery with corneal crosslinking (CXL), using riboflavin in combination with ultraviolet light, as the first option to be used for significantly delaying or, more often, stopping the progression of keratoconus, protecting the patient from a possible corneal transplant.

The first successful keratoconus surgery with corneal crosslinking (CXL) in Crete was performed at Emmetropia Eye Institute, on 19/09/2006, on a patient who was suffering from progressive keratoconus.


2. Corneal transplant

When the symptoms are severe, the ophthalmologist may recommend a corneal transplant. Your ophthalmologist will replace all or part of your diseased cornea with healthy corneal donor tissue. For more details on corneal transplants click here.


In any case, DO NOT rub your eyes!

If you suffer from keratoconus, try to avoid rubbing your eyes. This can damage the thin corneal tissue and make your symptoms worse.


If you have itchy eyes that make you to rub them, talk to your ophthalmologist about medications to control your allergies.