Diagnosis and Management of Keratoconus—A Narrative Review of Clinicians’ Perspectives

Song, Minji; Chen, Tanya; Moktar, Adam; Chan, Elsie; Chong, Elaine; Daniell, Mark; Sahebjada, Srujana

doi:10.3390/children9121973

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…The study included all eligible eyes with KCN [ 18 , 19 ] and contact lens intolerance that underwent femtosecond laser-assisted ICRS implantation [ 17 , 20 , 21 ] with a 3-month postoperative follow-up. We excluded eyes with previous ocular surgery or trauma, corneal opacity, or pellucid marginal degeneration; individuals with connective tissue diseases; and pregnant or breastfeeding women.…”

Section: Methodsmentioning

confidence: 99%

Corneal densitometry changes after femtosecond laser-assisted intracorneal ring segments implantation in keratoconus

Mounir,

Mohamed Mostafa,

Amer

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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Background: Intrastromal corneal ring segments are commonly implanted in the corneas of eyes with mild-to-moderate keratoconus; however, changes in corneal densitometry (CD) after implantation are a matter of debate in the current literature. We evaluated the changes in CD 1 and 3 months after femtosecond laser-assisted Keraring implantation. Methods: This retrospective, non-comparative, multicenter, case series study included patients with keratoconus who underwent femtosecond laser-assisted implantation of double segments with 90° and 160° arc lengths or two 160° arc length Keraring segments. Demographic and baseline clinical ophthalmic data were recorded. Corneal topography and tomography data acquired using a Pentacam HR Scheimpflug tomography system (Pentacam High Resolution; Oculus, Wetzlar, Germany) with a best-fit sphere were used as a reference surface. Using the Pentacam HR, CD measurements were acquired over a corneal area of 12 mm in total and at four concentric zones (0–2, 2–6, 6–10, and 10–12 mm) of three corneal stromal depths: 120 micrometers of the anterior corneal stromal layer, 60 micrometers of the posterior corneal stromal layer, and the central layer of stroma lying between these two layers. Results: We included 40 eyes of 40 patients, including 8 (20%) male and 32 (80%) female individuals, with a mean (standard deviation) age of 21.0 (6.4) years. We observed a significant improvement in the topographic values of steep keratometry (K), flat K, maximum K, and corneal astigmatism (all P < 0.05), but not in the mean K, thinnest corneal pachymetry, corneal thickness at the apex, back elevation, or front elevation (all P > 0.05). The mean total anterior, central, and posterior CD differed significantly among the time points, with a significant increase from the preoperative to the 1-month and 3-month postoperative visits (all P < 0.05) and no difference between those of the 1-month and 3-month postoperative visits (all P > 0.05). The mean CD for the anterior layer in the central, paracentral, and mid-peripheral zones, and the central layer in all four zones, differed significantly among time points, with a significant increase from the preoperative to the 1-month and 3-month postoperative visits (all P < 0.05), which remained unchanged from the 1-month to the 3-month postoperative visit (all P < 0.05), except for the central 2–6-mm zone, which decreased significantly from the 1-month to the 3-month postoperative visit (P < 0.001). The CD of the central 10–12-mm zone did not differ significantly in each pairwise comparison (all P > 0.05). In contrast, CD for the posterior layer in the paracentral zone decreased significantly from the preoperative to the 1-month and 3-month postoperative visits but increased, to a lesser extent, from the 1-month to the 3-month postoperative visit (all P < 0.05). Conclusions: Femtosecond laser-assisted Keraring implantation significantly changes CD, with improvement in most topography parameters. Further longitudinal studies with larger sample sizes are required to verify these preliminary findings.

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Section: Methodsmentioning

confidence: 99%

Corneal densitometry changes after femtosecond laser-assisted intracorneal ring segments implantation in keratoconus

Mounir,

Mohamed Mostafa,

Amer

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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“…Early-stage KC is typically managed with spectacles and contact lenses [ 3 ]. The best-corrected visual acuity (BCVA) in mild–moderate stages may be managed with intrastromal corneal ring segments (ICRS) [ 4 ] to achieve corneal flattening; however, this does not stop disease progression for most patients.…”

Section: Introductionmentioning

confidence: 99%

Collagen Crosslinking for Keratoconus: Cellular Signaling Mechanisms

et al. 2023

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Collagen crosslinking (CXL) is a widely used treatment to halt the progression of keratoconus (KC). Unfortunately, a significant number of patients with progressive KC will not qualify for CXL, including those with corneas thinner than 400 µm. The present study aimed to investigate the molecular effects of CXL using in vitro models, mirroring the normal, as well as thinner corneal stroma seen in KCs. Primary human corneal stromal cells were isolated from healthy (HCFs) and keratoconus (HKCs) donors. Cells were cultured and stimulated with stable Vitamin C resulting in 3D self-assembled extracellular matrix (ECM), cell-embedded, constructs. CXL was performed on (a) thin ECM with CXL performed at week 2 and (b) normal ECM with CXL performed at week 4. Constructs without CXL served as controls. All constructs were processed for protein analysis. The results showed modulation of Wnt signaling, following CXL treatment, as measured by the protein levels of Wnt7b and Wnt10a, correlated to the expression of α-smooth muscle actin (SMA). Further, the expression of a recently identified KC biomarker candidate, prolactin-induced protein (PIP), was positively impacted by CXL in HKCs. CXL-driven upregulation of PGC-1 and the downregulation of SRC and Cyclin D1 in HKCs were also noted. Although the cellular/molecular impacts of CXL are largely understudied, our studies provide an approximation to the complex mechanisms of KC and CXL. Further studies are warranted to determine factors influencing CXL outcomes.

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“…Despite the global consensus on KC and ectatic diseases published in 2015, 3 practice patterns differ globally. [11][12][13]47 National guidelines disseminated by OSU would standardize the clinical approach to manage KC across Kenya.…”

mentioning

confidence: 99%

Barriers to the Diagnosis and Management of Keratoconus Among Optometrists in Kenya

Rashid,

Moodley,

Mashige

et al. 2024

OPTO

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Background Early diagnosis and management of keratoconus (KC) are important for limiting visual complications of the disease. This study aimed to explore the perspectives of optometrists on the barriers to effective diagnosis and management of KC in Kenya. Methods An online questionnaire was distributed to optometrists in Kenya to collect data on barriers to the diagnosis and management of KC. Results The majority (60.9%) of optometrists were confident in retinoscopy and subjective refraction. Fewer were confident in the use of keratometers (46.4%) and corneal topographers (24.9%) and in the fitting of rigid gas permeable (RGP) contact lenses (25.0%). The most commonly reported barriers to improving their knowledge and skills were, limited continuous professional development opportunities (87.4%), high costs of conferences (86.1%) and the lack of diagnostic tools (79.5%). Impediments cited to diagnosing and managing KC effectively were a lack of national guidelines (64.9%), patient education material (71.5%), equipment (58.9%) and RGP supply (68.2%) and cost (67.5%). Most commonly reported barriers related to patients were compliance (91.4%), affordability (90.7%), RGP discomfort (89.4%), willingness to pay (88.1%) and the lack of patient education about KC (87.4%). Conclusion This study showed that the lack of national guidelines, essential equipment and adequate practitioner knowledge and skills were barriers to KC diagnosis and management. Regulation of optometric education and clinical practice, development of national guidelines for diagnosis and management of KC, up-skilling of practitioners and cost-effective solutions for equipment procurement and maintenance may improve both access to, and quality of, care to patients with KC.

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Diagnosis and Management of Keratoconus—A Narrative Review of Clinicians’ Perspectives

Cited by 6 publications

References 23 publications

Corneal densitometry changes after femtosecond laser-assisted intracorneal ring segments implantation in keratoconus

Corneal densitometry changes after femtosecond laser-assisted intracorneal ring segments implantation in keratoconus

Collagen Crosslinking for Keratoconus: Cellular Signaling Mechanisms

Barriers to the Diagnosis and Management of Keratoconus Among Optometrists in Kenya

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