Recent Combined Extraocular Modalities in the Treatment of Keratoconus.

Abstract

Keratoconus (KC) is a progressive, non inflammatory ectatic, bilateral (but usually asymmetrical) disease of the cornea, characterized by paraxial stromal thinning that leads to corneal surface distortion. Different modalities can be used for the treatment of keratoconus, more than 1 modality can be combined together as they are complementary to each other. Combined modalities include:

1. Piggy back contact lenses: A piggyback lens system consists of a rigid lens fitted on top of a soft lens. Indications for this technique are rigid lens intolerance or mechanical problems such as recurrent corneal erosion. 2. CXL and Intacs: Can be combined together either simultaneous (with Intacs implantation first) or sequential(either of them first) with better results in the simultaneous treatment. 3. CXL and CL: CXL makes the cornea more rigid and can tolerate

CL.

4. CXL and PRK: can be combined together both simultaneous and sequential, with better results in the simultaneous treatment. 5. Intacs and Phakic PCIOL: CXL can be followed (after 6 months)

by PCIOL implantation and corneal relaxing incisions.

6. DALK: A new technique in which the corneal tissues are removed down to the DM, decreasing the risk of rejection, and other intraocular complications as infection. DALK can be combined with either AK, Limbal relaxing incisions with adjustment sutures, PRK with MMC, and CL.