The most important symptom is permanent progressive eye numbers. At the first stage, the disease is needed a stop, because keratoconus is a progressive disease. The corneal map is the most valuable diagnostic method.
Keratoconus is a progressive disease characterized by that have genetical transitionary forward tapering of the transparent tissue in front of the eye.
The tissue is that known as the cornea is a tissue that protects the eye from external factors and ensures that the image is transmitted to the internal tissues in a healthy way, and it must have a certain curvature in order to fulfill this function.
Although the curvature is not standard for everyone, it is almost within certain limits. Keratoconus in overly steep corneas above these nerves discomfort should be considered.
Studies have shown that genetic predisposition and extremely eye irritation are the biggest risk factors. It is thought that the weakening of the corneal tissue in these individuals with a genetic predisposition may be due to the imbalance of some enzymes in the cornea.
Keratoconus occurs in people who are prone to the disease, especially after excessive exposure to ultraviolet rays from the sun, recurrent eye irritations, and severe constant eye scratching.
The disease usually occurs at the age of 10, but the person becomes aware of the disease at a later age. The disease has a progressive feature, generally progressing until the age of 40. In the beginning, the family notices a continuous improvement in the number of myopia and astigmatism in the child's eyes due to the cornea tapering to one side, and they have to change the numbers every 6 months.
In time, vision begins to become inadequate even with glasses. The majority of these children have a history of allergic conjunctivitis and itching. It is known that constantly scratching the eyes has a progressive effect on this disease.
This sharpening of the cornea is not an externally noticeable sharpness. However, in time, the disease progresses a lot, and when there is a sudden attack of water collection in the cornea, which we see in some patients, the sharpening of the eye becomes noticeable from the outside.
The most important symptom is permanent progressive eye number. In the beginning, vision is provided in a healthy way with glasses, in time, the person becomes blind even with glasses. In very rare moderate types, vision with glasses may be sufficient until the end of life.
The most noticeable complaint of the person is the blurred image. The patient cannot be comfortable with any glasses or standard soft contact lenses. Most of these patients have childhood allergic conjunctivitis and related complaints of itching, watering and redness. Rarely, in patients who are not noticed until advanced age, the patient may apply to the physician with a sudden attack of blistering in the cornea.
In a routine eye examination, when the physician sees a keratometry value that deviates from the normal and steepened in the auto refractometer values of the patient, and especially if the family is talking about progressive myopia or astigmatism of the child, the physician performs the necessary examination to examine the corneal map, which we call corneal topography, with the suspicion of keratoconus.
Corneal mapping is the most valuable diagnostic method in the diagnosis of keratoconus. Diagnosis is made by topography. In some early-stage cases, the term suspected keratoconus is used and the patient is kept under close follow-up. In addition to the topography, the patient's corneal thickness values are also measured.
The first stage should need to stop the disease because keratoconus is a progressive disease. The cornea has some tissue features that are tightly connected and clamped together.
In keratoconus, these ligaments are separated from each other and continue to separate. Due to separation, the resistance of the cornea has decreased and it has become unable to maintain its natural curvature. The patient's cornea changes shape and tapers forward. As a result of this sharpening, an increase in myopia and astigmatism values occurs in the patient. The first purpose of stopping treatment is to strengthen these ligaments and stop the forward straightening.
In the treatment we call cross-linking treatment, the intra-corneal cross-links are strengthened with drops dripped onto the eye surface, and then the clamping process of the cross-links applied to the UV pile is performed. If necessary, this treatment can be repeated several times at regular intervals.
The second stage of treatment is aimed at improving the person's vision. In these patients, vision does not improve with glasses or standard soft lenses, because the problem here is due to the cornea that is tapered forward.
It is ensured that the pointed cornea is somehow pressed inward and the cornea reaches the curvature it should be. For this, hard contact lenses or intracorneal ring treatment is applied. The purpose of both is the same.
A hard contact lens has a hard structure due to its material feature and has a flattening feature on the sharpened cornea so that the patient can see better. Likewise, in the corneal ring treatment, the cornea is stretched from the sides like a pulley with the ring inserted into the cornea, and the anterior sharpness is tried to be normalized. Again, the aim is to increase the patient's vision.
In the last stage, corneal transplantation is planned for patients whose vision cannot be improved by any method. It is the group with the most successful transplants among corneal transplants.
The treatment is applied in an operating room. The epithelium on the anterior surface of the cornea is scraped (or sometimes not) and riboflavin drops are instilled on the corneal surface for half an hour. This drop is dripped in order to strengthen the intra-corneal cross-linkage, which is disrupted in keratoconus, and then with the blue UV light applied, the dripped riboflavin is fully clamped to the ligaments and the strengthening process is completed.
The treatment is applied to stop the disease or at least slow its progression. The patient does not expect a difficult process after the treatment. There may be watering and stinging complaints on the first night of treatment, and the patient can continue his/her daily life.
The purpose of corneal ring treatment is to improve vision. Increasing the vision is not possible if the anterior cornea is not pressed inward and the cornea was up and about to its normal curvature.
The rings are placed in the cornea and they stretch the cornea from both sides like a pulley and flatten the central point. These rings, which are placed in the cornea, are placed in preformed ducts in the cornea. These ducts are created with the help of special tools or, more safely, with the help of a femtosecond laser.
After the ducts are created, the rings of appropriate thickness are placed in the ducts in accordance with the calculations made beforehand. The rings have a certain thickness and size that varies according to the level and stage of the disease. The size and thickness of the ring are determined by some special calculations made after prior topographic analysis.
The personalized ring is placed into the cornea with a very short procedure (5-6 minutes) in operating room conditions. The rings can also be easily removed when needed.