Cornea

Keratoconus

Keratoconus means “cone-shaped cornea.” An uncommon condition, Keratoconus, thins the cornea and changes its normally round contour to a cone-like bulge.

The cornea is the clear “front window” of the eye. As light enters the eye, it focuses the light rays to give you clear vision. With keratoconus, the shape of the cornea is altered and vision is distorted, making activities like driving, using a computer, watching television, or reading more difficult.

Keratoconus usually affects both eyes, although the symptoms experienced with one eye may be different than those experience with the other eye. The symptoms of keratoconus typically begins during a person’s late teens and early twenties and may include:

Mild blurring of vision
Slight distortion of vision
Increased sensitivity to light
Glare
Mild irritation
Increased nearsightedness or astigmatism
Frequent changes in eyeglass prescription

Keratoconus sometimes produces scar tissue that causes the cornea to lose its smooth texture and affects ability to see clearly.

We do not know what causes keratoconus, but some researchers believe that genetics plays a role; an estimated 10% of people with keratoconus have a family member with the condition.

Treatment for Keratoconus

Cornea Transplant
In a cornea transplant (also called a corneal graft or penetrating keratoplasty), a damaged or diseased cornea is replaced by donated corneal tissue that has recently been removed from a deceased person with no known diseases that might affect the viability of the donated tissue.
Intacs
The Intacs procedure is performed to stabilize the cornea, improve vision, and potentially eliminate the need for a cornea transplant. Intacs inserts remodel and reinforce the cornea, to improve vision by eliminating some or all of the irregularities caused by keratoconus. Anesthetic drops are used to numb the eye, then a single small incision is made is made in the surface of the cornea. A centering guide is placed on the surface of the eye and the surgeon gently separates the inner layers of the cornea to allow for insertion of Intacs. After insertion, the small opening in the cornea is closed.

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Fuchs' Dystrophy

Fuchs' dystrophy is a relatively common corneal dystrophy.

The cornea has three layers. The bulk of the cornea is called the stroma. The outer surface of the stroma is covered by the epithelium layer, which is several cells thick. A layer of endothelium lines the inner surface of the cornea.

The endothelium of the cornea is the primary area of pathology in Fuchs' corneal dystrophy. When the endothelium is unhealthy, the cells die, do not regenerate and they leave dots called “guttata” on the inside of the cornea. Guttata are often the first sign of Fuchs' dystrophy. Guttata cause glare and reduce quality of the vision.

In late stages of Fuchs' dystrophy, the corneal endothelial cells lose their ability to perform their primary duty, which is pumping fluid from the stroma. The stroma then accumulates fluid, causing corneal stromal edema, which makes the cornea become thicker. It also becomes more hazy, like a steamy window, and can cause a significant decrease in vision.

How is Fuchs’ Dystrophy treated?

When corneal stromal edema develops in the early stages of Fuch’s Dystrophy, medications can be used to improve vision. If this does not work, then cornea transplantation procedures are sometimes necessary to restore vision.

In the past a penetrating keratoplasty was performed. This procedure involved a full thickness transplantation with a prolonged recovery lasting often over 1 year. Dr. Fischer is offering the latest corneal transplantation procedures in which only the diseased layer of the cornea is removed and replaced with a transplant. This technique is call endothelial keratoplasty or “DSEK”. By replacing only the specifically diseased layer, patients can have a more rapid and safer recovery.