Keratoconus

Diagnosis and Management

1st Edition - June 13, 2022
Editors: Luis Izquierdo, Maria A. Henriquez, Mark J Mannis
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 7 5 9 7 8 - 6
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 5 9 7 9 - 3
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 5 9 8 0 - 9

Offering practical clinical guidance for early diagnosis and effective management, Keratoconus: Diagnosis and Management is a concise, easy-to-read guide to help mitig… Read more

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Offering practical clinical guidance for early diagnosis and effective management, Keratoconus: Diagnosis and Management is a concise, easy-to-read guide to help mitigate loss of vision in patients in a way that does not interfere with quality of life. From early diagnosis and intervention through the most up-to-date treatment and surgical approaches, this consolidated reference covers the essential information needed by cornea fellows and specialists, general ophthalmologists, residents, and optometrists.

Cover Image
Title Page
Copyright
Dedication
Contributors
Preface
Acknowledgments
Table of Contents
Section 1 Keratoconus Principles
Chapter 1 Keratoconus: A Brief History
In the Beginning: 17th and 18th Centuries
The 19th Century: The Age of Description
Late 19th and Early 20th Centuries: The Period of Emerging Therapies
References
Chapter 2 Keratoconus: Definitions
Key Concepts
Keratoconus: Definitions
Suspicious Topography Criteria
Unilateral KC
Consensus Needed in the Future
Acknowledgment
References
Chapter 3 Epidemiology of Keratoconus
Key Concepts
Introduction
Incidence and Prevalence
Epidemiological Characteristics and Risk Factors for Keratoconus
Conclusion
References
Chapter 4 Genetics of Keratoconus
Key Concepts
Evidence for Genetic Predisposition and Familial Inheritance of KC
Genome-Wide Association Studies
Transcriptomic and Expression Studies
Implementation of Genetic Insights in Clinical Practice
Conclusion
Abbreviations
References
Chapter 5 Pathophysiology of Keratoconus
Key Concepts
Introduction
Causation and Associations
Clinical Pathology
Histopathology and In Vivo Confocal Microscopy
Biochemical Pathology
Genetics of Keratoconus
Biomechanics in the Pathophysiology of Keratoconus
References
Chapter 6 Biomechanics of Keratoconus
Key Concepts
Introduction
Clinical Applications of Corneal Biomechanics
Chronic Biomechanical Failure of the Cornea (Keratectasia)
Ocular Response Analyzer
The Corvis ST
Brillouin Optical Microscopy
Conclusion
References
Section 2 Clinical Classification and Course
Chapter 7 Keratoconus Classification Systems
Introduction
Cone Morphology
Keratoconus Disease Severity Classification Systems
Classifying Keratoconus Progression
Conclusion
References
Chapter 8 Clinical Course and Progression of Keratoconus
Key Concepts
Clinical Course and Progression of Keratoconus: Current State of the Art
Keratoconus Progression Monitoring: New Insights
References
Section 3 Diagnosis and Associated Disorders
Chapter 9 Differential Diagnosis of Keratoconus
Key Concepts
Introduction
Ectatic Disorders
Corneal Tomography
Corneal Biomechanical Response
Higher Order Aberrations
Corneal Densitometry
Non-ectatic Disorders
References
Further Reading
Chapter 10 Keratoconus: Associated Systemic Diseases
Key Concepts
Introduction
References
Chapter 11 Inflammation in Keratoconus
Key Concepts
Introduction
Status of Inflammatory Factors in Keratoconus
Association Between Inflammatory Factors and Disease Characteristics
Inflammatory Factors and Keratoconus Pathogenesis
Inflammatory Factors Modulation and Keratoconus Management
Conclusion
References
Chapter 12 Psychology of Keratoconus
Key Concepts
Introduction
Psychological Roots of Keratoconus
Keratoconus and Personality
Physician Interactions
Two-Hit Hypothesis
Association With Mental Health Disorders
Modifications to Patient Counseling
References
Chapter 13 Artificial Intelligence in Keratoconus
Key Concepts
Introduction
Models of Artificial Intelligence in Keratoconus
Artificial Intelligence in Milder Forms of Keratoconus
Acknowledgment
References
Section 4 Imaging
Chapter 14 Corneal Topography in Keratoconus
Key Concepts
Introduction
Corneal Topography
Axial Versus Tangential Map
Corneal Topography in Suspected Keratoconus Cases
Red Flags
Indices
Final Considerations
References
Chapter 15 Scheimpflug Imaging for Keratoconus and Ectatic Disease
Key Concepts
Background
Elevation Maps
Enhanced Reference Surface and BAD Display
Belin ABCD Progression Display
Summary
References
Chapter 16 Dual Scheimpflug Tomography and Placido Topography
Key Concepts
Introduction
Tomographic Characteristics of Ectasia
Tomographic Characteristics of Asymmetry
Central Thinning and Corneal Volume
References
Chapter 17 Ocular Wavefront Analysis
Key Concepts
Introduction
Understanding Wavefront Aberrations
Types of Wavefront Systems
Corneal Wavefront Measurements
Total Wavefront for Diagnosing Keratoconus
Ray-Tracing Aberrometry for Ectasia Diagnosis
Impact of Wavefront Analysis in Refraction of Keratoconus
Conclusion
References
Chapter 18 Epithelial Thickness Mapping for Keratoconus Screening by VHF Digital Ultrasound or Anterior Segment OCT
Key Concepts
Introduction
History of the Measurement of Epithelial Thickness
Understanding the Predictable Behavior of the Corneal Epithelium
Case Examples
Automated Algorithm for Classification by Epithelium
Factors Influencing the Epithelium
Conclusion
References
Chapter 19 Confocal Microscopy
Key Concepts
Introduction
Corneal Epithelium and Subepithelial Nerve Plexus
Corneal Stroma
Descemet Membrane
Corneal Endothelium
Chapter Acknowledgment
References
Chapter 20 Other Diagnostic Imaging Tools for Keratoconus
Key Concepts
Background
Biomechanics
In Vivo Assessment of Corneal Biomechanics
Corvis ST in Keratoconus
Corvis ST in Suspected Keratoconus/Forme Fruste Keratoconus
Corvis ST in Refractive Surgery
Corvis ST in Cross-Linking
Corvis ST Limitations
Normal Corneas
Keratoconus Corneas
Cross-Linking
Limitations of Brillouin Spectroscopy
Ex Vivo Devices
Conclusions
References
Section 5 Non-Surgical Management
Chapter 21 Keratoconus: Diagnosis and Management With Spectacles and Contact Lenses
Key Concepts
Introduction
Scleral Lens Removal
References
Section 6 Surgical Management
Chapter 22 Surgical Planning in Keratoconus
Key Concepts
Background
Surgical Procedures
Intracorneal Ring Segments (ICRS)
Phakic Intraocular Lens
Keratoplasty: Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty
Surgical Planning
Kmax
Refractive Surgery Post Keratoconus Therapy (RESPKT)
Acknowledgment
References
Chapter 23 Intrastromal Corneal Ring Segments Mechanism and Techniques
Key Concepts
Mechanism
Techniques
PocketMaker Ultrakeratome
The Advantages of Femtosecond Laser Technique
Complications Encountered During Implantation
References
Chapter 24 Anatomy of Intracorneal Ring Segments for the Treatment of Keratoconus and Other Corneal Ectasias
Key Concepts
Anatomy of an Intracorneal Segment
Flat Segments
Conical
Thickness
Asymmetric Segments
Profiles of ISCRs
Arcs of the ISCRs
Using ISCRs in Different Topographic Patterns
Main Segment and Secondary or Accessory Segment
Topographic Stages and Their Most Frequent Patterns
Uncited References
References
Chapter 25 Intrastromal Corneal Ring Segments: Outcomes and Complications
Key Concepts
Introduction
Outcomes
Complications
References
Chapter 26 Corneal Cross-Linking: History, Physiology, and Techniques
Key Concepts
Basic Parameters
Experimental Studies
Clinical Studies
References
Chapter 27 Corneal Cross-Linking: Results and Complications
Key Concepts
Clinical Results
Complications
References
Chapter 28 Corneal Collagen Cross-Linking in Pediatric Patients with Keratoconus
Key Concepts
Introduction
Epi-Off CXL (Dresden Protocol)
Transepithelial CXL
Acknowledgment
References
Chapter 29 Corneal Laser Surgery for Keratoconus
Key Concepts
Introduction
Procedure Planning
Treatment Modalities
Corneal Laser Ablation and Cross-Linking: Sequential Versus Combined
Postoperative Stromal Haze
Outsourcing Aberrations Treatments
Conclusion
References
Chapter 30 Phakic Intraocular Lenses
Key Concepts
Introduction
Patient Selection
Combined Corneal Cross-Linking Plus Phakic Intraocular Lens Implantation
Combined Intrastromal Corneal Ring Segment Plus Phakic Intraocular Lens Implantation
Phakic Intraocular Lenses After Keratoplasty in Keratoconic Eyes
Complications of Phakic Intraocular Lens in Keratoconus
Conclusion
References
Chapter 31 Lamellar Keratoplasty in Keratoconus
Key Concepts
Introduction
Classification
DALK Techniques
Cannula Big Bubble
Pachy-Bubble
Bubble Size Optimization
Small Bubble Test
Bubble Deflation
Peeling Technique
Layer-by-Layer Manual Dissection
Pachymetry-Assisted Manual DALK
General Surgical Tips
Intraoperative Complications
Postoperative Complications
References
Chapter 32 Penetrating Keratoplasty in Keratoconus
Key Concepts
Introduction
Conclusion
References
Chapter 33 Combined Procedures for Keratoconus
Key Concepts
CXL-Plus
Chapter 34 Alternative Surgical Techniques: Bowman’s Layer Transplantation and Stromal Regenerating Techniques
Key Concepts
Introduction
Bowman’s Layer Transplantation
Stromal Regeneration Techniques
Crescent Keratectomy Assisted by Laser
References
Chapter 35 Cataract Surgery in the Keratoconus Patient
Key Concepts
Introduction
Preoperative Assessment
Intraocular Lens Power Calculation
Intraocular Lens Selection
Surgical Considerations
Combined Procedures
Special Situations
Posterior Keratoconus
Patient Expectations
Conclusions
Helpful Clinical Tips
Potential Pitfalls
References
Chapter 36 Cellular Therapy of the Corneal Stroma: A New Type of Corneal Surgery for Keratoconus and Corneal Dystrophies—A Translational Research Experience
Key Concepts
Background: From the Lab to the Patient
Translation to a New Type of Advanced Corneal Therapy
Bone Marrow Mesenchymal Stem Cells
Adipose-Derived Adult Mesenchymal Stem Cells
Umbilical Cord Mesenchymal Stem Cells
Embryonic Stem Cells
Induced Pluripotent Stem Cells
Corneal Stromal Stem Cells
Ocular Surface Implantation of Stem Cells
Intrastromal Implantation of Stem Cells Alone
Intrastromal Implantation of Stem Cells Together With a Biodegradable Scaffold
Intrastromal Implantation of Stem Cells With a Decellularized Corneal Stroma Scaffold
Anterior Chamber Injection of Stem Cells
Intravenous Injection of Stem Cells
First Clinical Human Experience in Advanced Keratoconus Cases
Results
Discussion and Conclusions
References
Chapter 37 Medical and Surgical Management of Corneal Hydrops
Introduction
Epidemiology and Risk Factors
Natural History
Pathogenesis
Diagnosis
Management
Conclusion
References
Section 7 Case Studies
Chapter 38 Central Keratoconus: Case Study
Case Study
Discussion
References
Chapter 39 Very Early Keratoconus: Case Study
Key Concepts
Case Study
Introduction
Diagnosis
Curvature-Based Topography
Elevation-Based Topography
Optical Coherence Tomography
Treatment
References
Chapter 40 Advanced Keratoconus: Case Study
Introduction
Intrastromal Corneal Ring Segments
Bowman’s Layer Transplantation
Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty
Conclusions
References
Index

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Keratoconus

Diagnosis and Management

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Luis Izquierdo

Maria A. Henriquez

Mark J Mannis