Treatment options for advanced keratoconus: A review

Area of Science:

• Ophthalmology
• Corneal Surgery
• Regenerative Medicine

Background:

• Advanced keratoconus (KC) traditionally managed with penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK).
• PK and DALK present challenges including surgical complications, graft rejection, and persistent astigmatism.
• These limitations drive the search for alternative treatments for advanced KC.

Purpose of the Study:

• To summarize current and emerging therapeutic options for advanced keratoconus.
• To guide corneal specialists in selecting optimal treatments for individual patients with advanced KC.
• To highlight alternatives to traditional keratoplasty procedures.

Main Methods:

• Review of existing literature on keratoconus treatments.
• Analysis of outcomes for established and novel surgical interventions.
• Comparison of efficacy and safety profiles of different treatment modalities.

Main Results:

• Ultraviolet crosslinking and intracorneal ring segments were initially limited to mild-to-moderate KC.
• Bowman layer transplantation shows promise for advanced KC, improving contact lens tolerance.
• Bowman layer transplantation may postpone or eliminate the need for PK or DALK in advanced cases.

Conclusions:

• Advanced keratoconus management is evolving beyond traditional keratoplasty.
• Bowman layer transplantation represents a significant advancement in treating advanced KC.
• Personalized selection of therapies is crucial for optimal outcomes in advanced keratoconus patients.