Cornea & KeratoconusAn Overview

Keratoconus is a progressive condition in which the cornea thins and bulges into a cone shape, causing distorted and blurred vision that glasses alone cannot fully correct. Treatment depends on the stage of the disease. In early to moderate keratoconus, corneal cross-linking with iLink can strengthen the cornea and halt progression. Intacs corneal ring segments and specialty contact lenses can improve vision. For advanced cases with significant scarring or thinning, a corneal transplant such as DALK or penetrating keratoplasty may be recommended.

Corneal cross-linking is a minimally invasive procedure that uses ultraviolet light and riboflavin (vitamin B2) drops to create new bonds between collagen fibers in the cornea, strengthening it and preventing further thinning. The FDA-approved iLink procedure is indicated for patients with progressive keratoconus or corneal ectasia after refractive surgery. Candidates must have adequate corneal thickness and documented progression. Your cornea specialist will review your topography and pachymetry to determine if you are a candidate.

These are different types of corneal transplant surgery, each designed to replace only the diseased layer of the cornea. PKP (penetrating keratoplasty) is a full-thickness transplant that replaces the entire cornea. DSEK and DMEK are endothelial transplants that replace only the innermost layer, ideal for Fuchs dystrophy and other endothelial diseases. DMEK provides the fastest visual recovery and lowest rejection rates. DALK replaces the front layers while preserving the patient's own endothelium, eliminating endothelial rejection risk. Your surgeon will recommend the technique that matches your specific condition.

Recovery time varies by transplant type. DMEK typically provides the fastest visual recovery, with many patients achieving functional vision within several weeks. DSEK recovery is slightly longer, generally several weeks to a few months. DALK and PKP involve longer healing, often 6 to 12 months for full visual stabilization because sutures remain in place for an extended period. All transplant patients require regular follow-up visits and will use prescription eye drops for months after surgery to prevent rejection.

Intacs are small, arc-shaped plastic ring segments that are surgically inserted into the middle layer of the cornea. They work by flattening the central cornea and reducing the irregular astigmatism caused by keratoconus. Intacs can improve vision enough to allow comfortable contact lens wear or, in some cases, reduce dependence on contacts altogether. They are reversible and can be combined with corneal cross-linking for enhanced structural and visual outcomes.

Keratoconus very rarely causes total blindness. However, without treatment, advanced keratoconus can cause significant vision loss from severe corneal thinning, scarring, and irregular astigmatism that glasses and standard contact lenses cannot correct. The good news is that corneal cross-linking can now halt progression in most patients when detected early. For those with advanced disease, corneal transplant surgery has a high success rate in restoring functional vision.

A pterygium is a non-cancerous growth of tissue on the conjunctiva that can extend onto the cornea. It is commonly associated with UV exposure and is sometimes called surfer's eye. Small pterygia may only require lubricating drops and UV protection. Surgery is recommended when the growth threatens the visual axis, causes significant astigmatism, restricts eye movement, or causes persistent irritation. Our surgeons perform pterygium excision with conjunctival autograft, which has the lowest recurrence rate.