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Minerva Oftalmologica 2008 June;50(2):43-58


language: English

Keratoconus therapeutic guidelines based on staging: from cross-linking to penetrating keratoplasty

Caporossi A. 1, Mazzotta C. 1, Baiocchi S. 1, Balestrazzi A. 1, Caporossi T. 2

1 Department Ophthalmology and Neurosurgery, Siena University, Siena, Italy 2 Ophthalmology Institute, Catholic University, Rome, Italy


Keratoconus is one of the most frequently encountered types of ectatic dystrophic degeneration of the cornea. It generally has its onset in adolescence, is bilateral, asymmetric and characterized by irregular astigmatism associated with thinning of the cornea. In approximately 20% of cases keratocornus requires lamellar and/or perforating keratoplasty, depending on the stage of the condition and the patient’s compliance with contact lenses. Technical advances in ophthalmology and widespread use of corneal topography and pachymetry in refractive surgery have revealed a considerable number of undiagnosed cases of keratoconus. In our experience, its real incidence is far higher (1 in 450 patients) than that reported in the literature (1 in 2000 patients). In Italy and elsewhere in Europe, keratoconus is the primary reason for corneal transplantation and has raised concern about its social and medical impact owing to the increasing number of younger patients seeking treatment. Advanced pathogenetic-based therapeutic options such as corneal crosslinking now permit prompt diagnosis and adequate treatment
based on correct clinico-diagnostic staging of the condition, its natural history, compliance with contact lenses, patient age and quality of life. There are three basic approaches to treatment: prevention or slowing down of progression during the refractive stage; correction or reduction of the refractive defect of aberrations; replacement of the ectatic cornea in the advanced stage in keratoconus recalcitrant to lens treatment. This review article describes current therapies according to the stage of the disease and provides useful practical guidelines derived from observation and treatment of thousands of cases from the authors’ clinical series.

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