All What You Need to know About Corneal Ectasia and How to Treat It

What Really Means to Have Corneal Ectasia

Corneal Ectasia is a complication that is able to damage the vision in a way that in its advance stages can even become into clinical iatrogenic keratoconus. Originated from the volatility of the cornea, the diagnosis is particularly challenging, because the corneas that present this condition look superficially normal, and the abnormalities are very difficult to identify.

The good news is that today advanced corneal imaging systems can detect earlier phases of some kinds of Ectasia which have genetic origins, and also can diminish iatrogenic causes of ectasias that come from for example LASIK and other types of corneal surgeries.Contact lenses can be also the cause of the condition, and even though sometimes the damage is lasting, the most of the times the situation come back to normal after that the patient stop using them.

Is common that contact lens specialist are the first persons that discover inflammatory problems or changes in refractive states. That’s why these kinds of professionals are specially qualified to support the diagnosis of the illness.

Diagnosis

The condition normally appears when individuals are living  their puberty age and continue progressing up to the 4th or 5th decade of life, but the rate of progression diminish and or definitely stops at the end of the 40s or beginning of the 50s.

Symptoms that are common to be seen in persons that suffer from Cornea Ectasia are for example; Rx changes in cylinder power and axis decrease in best corrected visual acuity, myopia, shadows or ghost images, and squeezing when seeing. Also an important signal that something is getting worrisome is the change in refraction in a person, and it is not normal to witness an alteration in the cylindrical component of the refraction in an adolescent. Beyond that, there are very few people with astigmatism that shows a change in the quantity of axis in the condition.

Corneal Topography Reading

Corneal Ectasia Treatment

Cornea Ectasia treatments are mostly multidiscipline ones, meaning that a standalone optometry treatment is restricted to the use of lenses that help to correct the condition.

Meanwhile the vision correction treatments for ectasias has improved significantly through advanced scleral contact lenses, lamellar surgeries and medically through collagen cross linking , no matter the origin of the complication the treatments to enhance the vision of ectasias are similar.

When corneal infiltrates are present there is a good chance of an ulcer and always need medical observation. Possible patients for refractive surgery are normally people showing irregular corneal topographies and recognizing keratoconus is to confirm the condition.

Lets point out,that the treatments for post-LASIK ectasia and keratoconus are similar, and the most popular treatments is the prescription of contact lenses, and as the last resource PK (penetrating keratoplasty).

Nevertheless the prognosis of PK nowadays is getting better and better, in the majority of cases can be avoided

Surgical alternatives to PK are also present, and for instance we could name augmentation corneal of the corneal stroma, anterior lamellar keratoplasty or collagen cross linking, a trial potential treatment that provokes the integration of the natural anchors that are located in the cornea. The procedure also avoid cutting across the visual axis, and even it may stop the evolution of keratoconus that would result in a more normal shape that would imply a better vision.

Causes

The origin of Ectasias can be attributed to iatrogenic or genetics causes, but the most frequently seen of genetics origins is keratoconus which is found in approximately 50 to 230 per 100,000 persons and consists in a non-inflammatory corneal condition.  Also the development of keratoconus sometimes is attributed to the second eye of unilateral, which is normally regarded as a contraindication to perform LASIK surgery.

Other cause of Iatrogenic ectasias is the result of consequences coming after to receive corneal refractive surgery. Although they are not common, when they happen are weakening,  and are seen in young persons, people who have had recurrent refractive surgery or patient that have preconditions like high thinner corneas, or high  myopia. The time frame in which most of the cases appear is from 3 to 57 months after the patient have receive the surgery, and also has been noted that patients affected had at least 1 risk factor present.

 Immunohistochemical Features

Post LASIK ectasia corneas showed RSB thinning, fewer areas of Bowman’s layer disruption and abnormally big artifacteous interlamellar cleft in RSB that were inferior than keratoconus, in Light microscopy and hematoxylin-eosin staining. Also TEM or transmission electon microscopy proved thinning of the collagen lamellae and loss of lamellar number in the RSB with diminishing of interfibril distance.

ISome mmunohistochemical assessment also showed that post-LASIK ectasia revealed abnormal EBM structure similar to bullous keratopathy and keratoconus increasing certain proteinases showing lysis and remodeling of EBM.

Beyond that confocal microscopic analysis after LASIK ectasia showed irregularly distributed extremely reflective collagen scars with reduced keratocyte density and background transparency at the anterior stroma compared to normal after LASIK corneas.

Also VSP Lasik is recognized for taking in to account all this pre conditions , and asses the  possibility to develop the procedure.

Corneal Ectasia Wrap

Breakthroughs in ectasia identification, prevention and treatment are seen often. Technologies also evolve, and for instance corneal tomography has improved immensely and today they can even recognize genetically caused ectasias prematurely. Several tomography systems combine result in corresponding views of the cornea in order to provide a more deep knowledge and finally intend to get rid of it completely. In the future there is a great possibility that people with Ectasia conditions can have a better visual rehabilitation treatment and more options in developing areas like the intrastromal corneal ring implantation, contact lenses, lamellar surgeries collagen, and crosslinking.

In the near future it is the possibility that we can eliminate fully the necessity for corneal transplantation.

As we can see this kind of genetic diseases are not easy to deal with, but with the exponential development of medical technology the ability of improving  the quality of life of people that suffers this conditions I not an utopia.

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