Keratoconus is a progressive disorder of the cornea, in which the central-to-paracentral area of the cornea thins and begins to protrude forward, resulting in the progression of severe myopic astigmatism and irregular astigmatism. Most mild cases are asymptomatic; however, as the disease progresses, severe astigmatism develops, resulting in poor spectacle-corrected visual acuity and requires correction by hard contact lenses. Furthermore, in severe cases, acute corneal hydrops (rupture of Descemet's membrane) can occur. For patients in whom correction of visual acuity by hard contact lenses is difficult or who have difficulty wearing such contact lenses, including scar formation following acute corneal hydrops, corneal transplant may be performed.
Corneal crosslinking (CXL) is a surgical procedure that halts the progression of keratoconus. It has been known that the corneal stroma consists of proteoglycans crosslinking the parallel-running collagen fibrils and that this structure increases with age. With CXL, this crosslinked structure is artificially enhanced, thereby improving the rigidity of the cornea and making deformation difficult, which is thought to halt the progression of the illness.
This report aims to promote the popularization of CXL for keratoconus patients in a more reliable and safer manner. In this paper, we share information, even if only a small amount, about treatment options thought to have a high scientific rationality with patients and medical practitioners. We will consider the wishes and beliefs of the patients, as well as the ethical and social limitations of medical practitioners, and upon agreement between the patients and medical practitioners, we could not be happier if this helps in choosing the best treatment method.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 509-522, 2021.