Keratoconus: how to protect your eyes from a gradual drop of vision

this condition is one of the  most popular chronically or slowly progressive ocular conditions that takes years to affect and impair a person’s vision. In this condition the cornea, the clear window at the front of the eye loses its natural spherical contour, and becomes thinned out ,bulging out at weak points and assuming a conical shape. This abnormality of shape and contour affects the bending of light rays at the corneal interface , causing irregular bending and defocus of these rays when they fall onto the retina, leading to drop of visual clarity and acuity. The condition affects one or both eyes with varying degrees, and the average age of affection is between 15 -25 years . 

What causes keratoconus?

The actual cause is unknown yet, but  research has shed light that a deficiency of certain building enzymes within the corneal stroma.  

The wear and tear that is constantly repaired by these enzymes is slowed down, causing excessive accumulation of diseased collagen fibers and oxygen free radicles, leading to weakening of the corneal stromal bridges, and hence weakness  and forward bulge of the cornea. 

Research has also linked the condition to certain hereditary factors and genetic conditions, which highlights the importance of family history in this condition. 

In addition, excessive unprotected exposure to sunlight and constant eye rubbing have also been implicated. Also, the misuse of poor-quality contact lenses has also been added to the predisposing factors. 

Available treatment options:

At the early stages of the disease , glasses and/or rigid contact lenses (Rose -K, RGP) can be used to treat the condition according to your doctor’s decision. 

As the condition worsens however, your ophthalmologist or eye surgeon may resort to corneal collagen cross linking or intracorneal ring implantation. 

What are the common symptoms for keratoconus?

Patient’s with this condition notice that their vision becomes gradually blurred and unclear with frequent change of their glasses prescription.

 This subtle symptom may progress over years or months and may affect both eyes and one eye more than the other .

 the most common early symptoms include 

  • Blurring of distant and near vision despite wearing the proper optical correction
  • Straight lines appear bent or skewed at different angles
  • Increased sensitivity to ,light and increased sense of haloes around the light 
  • Redness and swelling of the eye

Later symptoms become more ominous and include 

  • Increased blur and visual distortion that does not respond to  any form of optical correction
  • Intolerance to contact lenses
  • Progression of myopia and astigmatism

What are the various surgeries that can be used to treat the condition?

Corneal collagen cross linking:

 this procedure uses ultraviolet light rays and concentrated vit B2 eye drops to create and strengthen the interconnecting bridges between the collagen fibers in the corneal stroma, making it stronger and less liable to bulge. 

The vitamin B2 drops are instilled onto the eye over a period of 30 minutes, this is followed by further 30 minutes of ultraviolet exposure. 

intracorneal ring implantation

 these semicircular devices made of PMMA are inserted into tracks created within the stroma of the diseased cornea and help to restore visual clarity and acuity by flattening the cones and increasing corneal thickness therefore creating a smoother refractive surface and regular light refraction onto the retina.

Corneal implantation

 if the cornea is severely thinned out or damaged you might need to have it partially or fully replaced by  donor tissue. This surgery restores the natural anatomy of the cornea and may provide best visual outcomes for some cases

Not all keratoconus patients have the same condition or follow the same treatment protocol, or  respond to the same treatment modality, each treatment option is specifically tailored according to the presented case 

The cost of intracorneal ring implants in Egypt

The cost of intracorneal ring implants in Egypt

Treatment of keratoconus with intracorneal rings

The treatment of keratoconus with intracorneal rings is one of the most effective ways to treat the condition, and is done by placing half-circle or full circle segments of rings into tunnels created in the corneal. 

Mechanism of treatment of keratoconus with rings

  • Topical anesthesia is first instilled to numb the eye and prevent any discomfort
  • The rings are implanted at the periphery of the cornea  so that the center of the cornea remains free without being touched. They are implanted in carefully constructed tunnels , which can be either created manually or by femtosecond laser 
  • The rings are inserted into the cornea.
  • They aim at  reducing irregular astigmatism by supporting the base of the cone and flattening the bulge
  • These rings can be removed if necessary, but in such a case, the cornea will return to shape before surgery.

Advantages of the implantation of keratoconus rings

  • The main purpose of treating keratoconus with rings is to restore the shape of the natural eye and allow the patient to tolerate  contact lenses.
  • This type of treatment is fairly good, especially for people who do not want to have a corneal transplant keratoplasty in Egypt.
  • This treatment can improve vision c=and can be accompanied by eyeglasses

What are the steps of the operation?

  • Before starting this procedure, anesthetic eye drops are applied first.
  • After that, the doctor applies the eyelid speculum, which essentially keeps the eye open during the procedure.
  • The doctor creates a tunnel inside the cornea, by laser or manually.
  • The rings are then inserted into the cornea
  • Then, at the end of the procedure, the doctor applies drops and a plastic shield for protection.

Cost of implanting intracorneal rings for  keratoconus in Egypt

In Egypt it is considered a common operation, it varies in cost and depends on several main factors which are the type of tunnel creation procedure used in the operation, the hospital and doctor fees, and the cost of the rings and their type. 

What are the conditions for implanting intracorneal rings?

  1. There should be  no opacity (scar) on the surface of the cornea (cornea must be clear).
  2. The corneal thickness should be within normal limits 

What are the expected results after the procedure?

  • Vision is expected to begin to improve in the week following the procedure by 50%  but may fluctuate for several days until it stabilizes, and most people can return to work one or two days after the treatment.
  • Additional procedures may be used to  complement procedures such as corneal stabilization and other techniques.
  • It may be done more than once with various ring sizes and positions to accommodate the changing corneal parameters .

What are the rings used to treat keratoconus?

implantation of PMMA rings or ring segments, where they act as stents, and  are installed to adjust and stabilize the degree of corneal curvature.

These rings are made up of one or  two semicircular sections, implanted in the cornea, on outside the optical zone, and there are also full segment  rings, the type of ring is chosen according to the condition of each patient. 

These rings are made of solid materials ,PMMA, by installing them in the cornea, they make changes in the shape of the cornea and reduce the bulging cone and provide stability.

What cases require a  corneal transplant?

There are many cases in which corneal transplantation is used in Egypt.

  • Advanced keratoconus. 
  • extreme thinning of the cornea.
  • Scarring or swelling of the cornea, caused by infection or injury.
  • Corneal ulcers and scars , including those caused by infection and not responding to treatment.

It is known that

  • Corneal transplantation contributes to restoring vision, reducing pain, improving the appearance of damaged or sick cornea, or improving its appearance.
  • Most corneal transplants are successful, but corneal transplantation has complications, such as rejection of the donor cornea, so post-operative car and follow up are essential.

The cost of corneal transplantation in Egypt

Results of corneal transplantation

  1. Most people undergoing corneal implants at least partially regain their sight, depending on the cause of the surgery and the patient’s health and eye condition.
  2. Close follow up is needed  because there is a possibility of complications and rejection of the cornea even after years after corneal transplantation, and corneal rejection can often be controlled by medications.
  3. You may need to correct your vision after surgery, and it may take several months for your vision to improve.
  4. When the transplanted  cornea fully heals and recovers – several weeks to several months after surgery, you doctor will make some adjustments that can improve your vision.

Some of these are :

  • Correction astigmatism: meaning that stitches that held the  cornea in place in the patient’s eye can lead to corneal irregularities and astigmatism, causing blurring of vision at some points.

Part of this may be corrected by removing some stitches and tightening others .

  • Correction of other vision problems:  Refractive errors, such as myopia hyperopia can be corrected by wearing glasses, contact lenses or laser eye surgery in some cases.

What is the cost of intracorneal ring implants in Egypt?

The cost of intracorneal ring implant in Egypt using the femtosecond laser device also varies according to the doctor’s skill, experience , knowledge. In addition to the  specifications of rings used in the surgery and whether they will be inserted manually or by Femtolaser which is currently used in Egypt and  is considered to have guaranteed and safe results.

Best Eye Surgeon in Egypt

A lot of skill knowledge and experience is needed and is imperative  for the diagnosis of keratoconus in its early stages  and its modalities of treatment, including the type, placement and thickness of the rings, and whether additional surgeries will be done. The best option for you is to look for the best eye surgeon ophthalmologist  specialized in keratoconus surgeries known for their efficiency and guaranteed results.

 Hence comes Dr. Ashraf Hassan Soliman consultant of keratoconus and corneal surgery, cataract and glaucoma  surgery, refractive surgery and laser vision correction on the top of the best ophthalmologists and  as the best doctor for the treatment of keratoconus in Egypt.