Refractive surgery for keratoconus

Abstract

Traditionally, keratoconus has been managed with glasses when mild, contact lenses when moderate and keratoplasty when severe. When cornea‐based refractive surgery was first developed it appeared to be a useful option for keratoconus until reports of post‐operative progressive ectasia emerged and thus keratoconus was considered a contraindication to refractive surgery. However, improvements in older techniques and the development of new techniques mean that there are now several viable options to avoid keratoplasty in contact lens‐intolerant patients. This review discusses the risks and benefits of excimer laser refractive procedures, both with and without corneal collagen cross linking, as well as intra‐corneal ring segments, phakic intraocular lenses and refractive lens exchange with toric intraocular lens implantation.

Key words:

• cornea
• intra‐corneal ring segments
• intraocular lenses
• keratoconus
• photorefractive keratectomy
• refractive surgery