Keratoconus treatment

Collagen cross-linking

Keratoconus can be corrected by wearing glasses or contact lenses if it’s not too severe. However, to cure keratoconus you will need surgery. This can be a corneal transplant (keratoplasty) or corneal implant. There is also a relatively new therapy called cross-linking eye surgery or collagen cross-linking (also called CXL or C3R2).¹

Cross-linking surgery can be done in a 30-minute outpatient procedure. It is effective in 94% of patients.¹ The main aim of cross-linking surgery is to prevent your keratoconus from getting worse, so it’s only suitable if your cornea is still getting more distorted. It also isn’t safe if your cornea is extremely thin.¹ It’s usually done on one eye at a time.²

Your cornea is made up of several layers. The middle one, called the stroma, consists of a web of collagen fibres linked together. If you have keratoconus, these links aren’t strong enough to give your cornea the proper shape, so it bulges outwards into a cone shape. Cross-linking surgery helps to increase the number of these collagen fibres, making your cornea stronger.²

The cross-linking procedure is usually done under local anaesthetic. It involves removing a small piece of the surface of your cornea, giving you eye drops containing vitamin B2 (riboflavin), and then exposing your eye to ultraviolet light.²

Corneal implants

Another option for surgically treating keratoconus is corneal implants. These are plastic rings which are inserted into your cornea to help it keep the correct shape. This is usually done on both eyes at once, under general or local anaesthetic. The implants usually don’t actually cure the keratoconus by themselves, but they can make it easier for glasses or contact lenses to correct it. They can also change the shape of your cornea, which helps contact lenses to fit better.²

Corneal transplant

A corneal transplant is where some or all of your cornea is removed and replaced with a healthy, donated cornea. If your doctor believes you will benefit from a corneal transplant, they will probably try a partial corneal transplant first, which is called deep anterior lamellar keratoplasty. This is where the outer layers of the centre of your cornea are replaced with donor tissue, but the innermost layer is left untouched.²

If the inner layer of your cornea is damaged, or if you’ve already had a partial transplant and it hasn’t worked, you may be offered a full transplant. This is called penetrating keratoplasty. It involves replacing the whole of your cornea with a donor one.²

In either case, the donor cornea will be held in place with tiny stitches. These need to stay in place for a long time: six months for a partial transplant or 12 months for a full one.²

After the surgery it can take a long time to recover. You will probably need to use steroid eye drops for at least six months to prevent your body from rejecting the donated cornea, and these increase the risks of cataracts and glaucoma.²

95% of full transplants, and an even higher proportion of partial transplants, are still healthy after five years. However, after 20 years, 50% of full transplants will have failed. For this reason, your doctor may recommend that you wait as long as possible before having the surgery, especially if you’re younger.²

Keratoconus treatment

Corneal implants

Corneal transplant

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