title: Treatment options for advanced keratoconus: A review.
abstract: Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA.
authors.forename: Jack S
authors.initials: JS
authors.lastname: Parker
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands.
authors.forename: Korine
authors.initials: K
authors.lastname: van Dijk
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands. Electronic address: research@niios.com.
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D016039:Corneal Transplantation; D003432:Cross-Linking Reagents; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D015948:Keratoplasty, Penetrating; D017319:Photosensitizing Agents; D019919:Prosthesis Implantation
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents
keywords: Bowman layer transplantation; DALK; UV crosslinking; advanced keratoconus; intracorneal ring segments; review