Keratoconus

Keratoconus involves the cornea. The Cornea is the first and most powerful lens of the eye, and critical for clear vision. The word Cornea means “tough and horny”, because its structure resembles an animal’s horn and it is tough because it forms the front wall of the eye.

With Keratoconus, the cornea is thinned and deformed into a cone shape. Patients experience both BLUR and DISTORTION but can’t tell the difference. Glasses, soft contact lenses, or hard contact lenses may help, however, to restore optical clarity, surgery may be required.

Keratoconus runs in families, occurs usually at a young age, affects both eyes differently and worsens with rubbing.

A patient may not be aware that they suffer advanced Keratoconus if one eye sees normally. When both eyes have severe disease, patients tend to adapt to the distorted vision and think they see normally.

In most cases, Keratoconus progression stops by ceasing eye rubbing. If not, collagen cross linking may help.

Transplantation Surgery for Keratoconus

If vision does not improve with glasses, or if contact lenses become intolerable, Stromal Corneal Transplantation is the procedure of choice to restore vision. A Stromal Transplant replaces the stretched and thinned structural layer of the cornea with donated human corneal tissue, restoring the normal corneal shape and thickness. The risk of sight threatening endothelial rejection is removed, as is the risk of glaucoma and infection inside the eye. Furthermore because Stromal Corneal Transplantation replaces only PART of the cornea, the eye remains strong.

Dr Anthony Maloof, corneal surgeon in Sydney has performed a corneal transplant for someone suffering from Keratoconus. The image shows the suture used to hold the tissue in place.

The Golden rules for transplantation success

These three rules must never be broken:

NEVER RUB YOUR EYES
Use your drops as prescribed
Attend all your appointments

Stromal Corneal Transplantation is not for everyone. If Keratoconus is left too long, the cornea may rupture so that a Full Corneal Transplantation is required. Determined by assessment only.

After Surgery

Typically, we advise up to 2 weeks off work, although you may return to work sooner if you feel well enough. Dr Maloof will typically see patients at week 2, month 1, month 3, 6, 12. After this, you will have 6 monthly appointments until the stitches are removed. At no stage will you need anti-rejection tablets. Continue drops until stitches are removed. Stiches are removed at around 18 months.