Keratoconus Surgery

Keratoconus is a progressive eye condition that affects the cornea which may impair vision as the condition progresses.

Advances in medical technology have made it possible to manage keratoconus through different surgical options that offer improved quality of life and vision.

Keep reading to know more about keratoconus and the different surgical options to treat it!

Overview Of Keratoconus

Keratoconus is an eye condition in which the cornea gradually becomes thinner and bulges outward into a cone shape, affecting vision. It may cause blurred vision and sensitivity to light and glare.

It usually affects both eyes but may affect one eye more. It usually affects people in their teens, 20s and 30s.

Causes And Stages Of Keratoconus

The exact cause of keratoconus is not known but it is believed to be linked to genetic and environmental factors. However, the following factors may play a role in its development

Family history of keratoconus
Frequent eye rubbing
Underlying health conditions, including Down syndrome or connective tissue disorders
Oxidative stress
Atopy

The different stages of Keratoconus are

Stage 1- Early keratoconus: Minimal corneal steepening and little to no scarring.

Stage 2- Moderate keratoconus: Increased corneal steepening and possible scarring

Stage 3- Advanced keratoconus: Substantial corneal thinning, bulging, and scarring.

Stage 4- Severe keratoconus: A very thin and bulging cornea with extensive scarring.

Symptoms Of Keratoconus

The main symptoms of keratoconus are

Worsening of vision in one or both eyes.
Having double vision when you look out of just one eye.
Halos around the bright lights
Increased sensitivity to bright light and glare.
Distorted vision in eyes.
Need for frequent changes of eyeglasses

It is important to contact your Ophthalmologist if your eyesight is worsening rapidly.

Treatment Of Keratoconus

Treatment of keratoconus depends on the severity of the condition and the stage of keratoconus.

Eyeglasses or contact lenses: Mild to moderate keratoconus can be treated using eyeglasses or contact lenses. Different lenses used are
- Soft contact lenses
- Gas-permeable contact lenses
- Piggyback lenses
- Hybrid lenses
Surgery: Surgery may be required if there is corneal scarring, extreme thinning of the cornea, and in individuals who are unable to wear any type of contact lenses. The different surgical options available are
- Corneal cross-linking
- Topography-guided conductive keratoplasty
- Penetrating keratoplasty (corneal transplant)
- Deep anterior lamellar keratoplasty
- Intacs

Preparing For Keratoconus Surgery

If you are preparing for keratoconus surgery, it is advisable to follow the precautionary steps.

It includes

Stop using the prescription eyeglasses or contact lenses a few days before the surgery
Avoid using eye makeup on the day of keratoconus surgery as they may breed bacteria.
Avoid wearing perfume or after-shave lotion.
Eat a light meal and drink adequate fluids.
Adhere to the doctor’s instructions and discuss any concerns about the surgery beforehand.

The choice of keratoconus surgery may depend on the stage of keratoconus, corneal thickness, corneal thickness, and the patient’s needs and preferences. It is an outpatient procedure and recovery time depends on the procedure.

The different keratoconus surgeries performed are

Penetrating Keratoplasty (Corneal Transplant)

A corneal transplant is commonly performed surgery to treat severe keratoconus. It involves removing the damaged section of the cornea and replacing it with a healthy one.

Procedure:

You will be applied eye drops to help you relax. Your surgeon may use either local or general anaesthesia. The surgeon will put a device on the eye to keep it open.
Your surgeon may perform one of the following corneal transplants based on the specific need. In a few individuals, the surgeon will remove a circular part of the cornea and replace it with the donor cornea’s matching portion. In others, very thin layers of cells from the front of the cornea will be replaced with donor tissue. In some cases, only the damaged inner layer of the cornea will be removed and replaced with a thin disc of healthy donor tissue.
The surgeon tapes the shield over the eye.

Benefits:

Corneal transplant offers many benefits, including improved vision, symptom relief, better quality of life, and a high success rate.

Side effects:

Some side effects are infection, glaucoma, clouding of the eye lens, and corneal scarring.

Corneal cross-linking

Corneal cross-linking is a minor minimally invasive procedure that helps to prevent the cornea’s shape from getting steeper by strengthening the weakened collagen fibres of the cornea.

Procedure:

Your Ophthalmologist may give drops to numb the eyes.
The surgeon removes the thin, outer layer of the cornea to allow the medication to reach deeper into the cornea.
Vitamin B eye drops are applied to the cornea for up to 30 minutes
A special device is used to shine a focused beam of UV light at your cornea for 30 minutes to activate the riboflavin in the cornea.
A bandage contact lens is placed over the eyes to help the cornea heal and is left in place for a week.

Benefits:

Corneal cross-linking helps in improving corneal strength and delays or avoids the need for a corneal transplant.

Side effects:

Some potential side effects include eye infections, eye pain, swelling, blurred vision, delayed healing, and corneal scarring.

Topography-guided conductive keratoplasty (Topography-guided CK)

Topography-guided conductive keratoplasty is a noninvasive procedure that uses radiofrequency energy to reshape the irregular corneas and thus helps to improve the focusing power of the eye.

Procedure:

The eye is mapped using corneal topography to create a precise map of the cornea’s shape and curvature which helps the surgeon to identify the areas where the cornea needs reshaping
Using a special device, radiofrequency energy is applied to the peripheral areas of the cornea which heats the cornea’s upper layer, shrinks it to reshape the cornea, and enhances the refractive power.

Benefits:

Topography-guided CK is non-invasiveness, provides quicker recovery and minimal discomfort for individuals.

Side effects:

Common side effects are a gritty feeling in your eyes that wears off with time, corneal regression requiring a repeat procedure, and corneal aseptic stromal necrosis.

Deep anterior lamellar keratoplasty (DALK)

DALK is a procedure that is used for individuals with advanced keratoconus. It involves only the removal of the top layers of the cornea leaving the inner endothelial layer intact.

Procedure:

Local anaesthesia is administered via eye drops or an injection around the eye to numb the area. The surgeon may use a speculum to keep the eyelids open.
The surgeon removes the damaged top layers of the cornea using specialised instruments leaving the inner endothelial layer.
He then removes endothelium-Descemet’s membrane from the donor’s cornea and places the graft within the recipient’s membrane.
The donor graft is secured with stitches.

Benefits:

The patient’s endothelial layer remains intact and DALK offers a quicker recovery time than corneal transplantation.

Risks:

Some risks and side effects associated are graft rejection, corneal swelling, infection in the healing area, and posterior scarring.

Intacs (Implantable Ring Segments)

Intacs is the brand name of the device used in keratoconus treatment. It is a small clear plastic arcs that are inserted into the substance of the cornea of keratoconus individuals. It is used as an alternative for corneal transplants.

Procedure:

The surgeon numbs the eyes of the patient using a topical anaesthetic. The surgeon then places a speculum in the eye.
A small incision is made in the cornea and a centering guide is placed on the eye to keep it steady.
The surgeon inserts the Intacs after separating cornea layers and closes the incision with one suture or with tissue glue.

Benefits:

No tissue is removed in Intacs, improvement in vision can be noticed on the same day and does not involve any maintenance.

Risks:

Possible adverse effects are eye infections, problems with night vision, halos, and blurry or fluctuating vision.

What is the Cost of Keratoconus Surgery in India?

The cost of keratoconus in India may vary depending on several factors including

Type of surgery and severity of keratoconus
Location of surgery
Surgeon’s experience and reputation
Pre-operative and post-operative care
Equipment used
Donor cornea for transplants

It is important to consult an experienced Ophthalmologist to get an estimate of keratoconus based on your specific condition.

Grewal Eye Institute is a renowned eye care center in India offering cost-effective treatments for different eye conditions, including keratoconus.

Why Choose Grewal Eye Insitute for Keratoconus Surgery?

Grewal Eye Institute, located in Chandigarh is a leading eye care center specialized in the treatment of keratoconus.

With a combination of cutting-edge technology and personalized approach, the institute is committed to providing exceptional care to patients.

There are a few reasons that set Grewal Eye Institute that sets Grewal Eye Institute apart:

World’s 4th JCI certified eye hospital acclaimed for quality and excellence
Leaders in Eye Care since 1993
10000+ surgeries per year
Successfully treated 70000+ patients per year
Expert Eye care team of sixteen expert Opthalmologists
Personalized care for all
Patient satisfaction
Affordable yet high-quality care
Positive reputation and testimonials

If you need surgery for keratoconus, Grewal Eye Institute provides comprehensive treatments that cater to all stages of keratoconus.

If you have any questions regarding keratoconus surgeries, please feel free to contact Dr Grewal and his team of Grewal Eye Institute for expert guidance.

Frequently Asked Questions

Can keratoconus damage vision?

Keratoconus requires immediate attention and if left untreated or if it progresses may significantly damage vision. It may lead to progressive vision loss, scarring, rupture of the cornea, and loss of functional vision.

How long will it to recover from keratoconus surgery?

The recovery time after keratoconus surgery may vary depending on the type of the treatment. It may take few days for some treatments and much more for others depending on the complexity.

Can you prevent keratoconus?

No, there is no known way to prevent keratoconus as its exact cause is not fully understood. However, fewer steps, including avoiding eye rubbing, wearing protective eye wear, genetic counselling, and managing allergies may help in reducing the progression of keratoconus.