Keratoconus is an absolute contraindication to corneal laser. Beijing mingshiguang Ophthalmology, as a specialized medical institution for myopia surgery, has been studying the screening, timely diagnosis, treatment and control of keratoconus, and has made innovative progress in the early diagnosis and treatment of keratoconus. In particular, it has developed the technology of corneal stromal lens implantation combined with corneal cross-linking in the treatment of keratoconus. The corneal stromal lens removed in full femtosecond surgery is implanted into the corneal stromal pocket of keratoconus patients, and the cornea is padded thick for cross-linking, so that more patients can control the development of the disease in time.

1、 Who is prone to keratoconus?

The risk factors of keratoconus are various, such as long-term eye rubbing, allergic conjunctivitis, eyelid relaxation syndrome and other reasons. Moreover, 13.5% of keratoconus patients have a family history and have a certain genetic tendency, suggesting that if there are keratoconus patients in the family, it is suggested that the relevant family members should also regularly check the corneal topography.

Early keratoconus can be corrected by frame glasses. When vision correction is not satisfactory, rigid gas permeable contact lens (RGP) can be considered to improve vision, but neither frame glasses nor RGP can prevent the progression of the disease.

Therefore, once keratoconus is found, surgical treatment should be considered as soon as possible: through corneal collagen cross-linking, improve the hardness and strength of the corneal stroma, so as to control or delay the progression of the disease. If keratoconus continues to develop and the cornea is too thin, keratoplasty is needed. Therefore, it is suggested that the problem of keratoconus should be found and treated early.

Professor zhouyuehua said that the diagnosis of typical keratoconus is not difficult, but the early clinical manifestations of the lesion are not typical, and the diagnosis is difficult. We should focus on the comprehensive judgment according to the morphological manifestations of corneal topography, especially the changes of local refractive power, local thickness, and the differences between eyes. Patients with suspected keratoconus should be followed up regularly to track the changes to rule out pseudokeratoconus.

Beijing Ming Vision & Ophthalmology department has made innovative progress in the diagnosis and treatment of keratoconus in recent years, especially the technology of corneal stromal lens implantation combined with corneal cross-linking in the treatment of keratoconus. The corneal stromal lens taken out in the full femtosecond operation is implanted into the corneal stromal bag of keratoconus patients, and the cornea is padded thick and then cross-linked, so that more patients can control the development of the disease in time.

3、 Treatment of keratoconus

1. corneal crosslinking

Corneal cross-linking surgery (CXL) is a minimally invasive corneal reinforcement treatment, which is commonly understood as strengthening and protecting the cornea.

Laser corneal refractive surgery to correct myopia is to do "subtraction" (cutting thinning) on the cornea. If the cornea itself is weak, it must be strengthened. Therefore, in the course of carrying out corneal laser surgery in Mingshi Ophthalmology, for patients with abnormal cornea, cross-linking reinforcement of the cornea membrane should be carried out synchronously to prevent and control the risk of postoperative keratoconus.

Corneal cross-linking can improve the hardness, strength and biomechanical stability of the cornea just like "exercise can strengthen the muscle". It uses the photochemical reaction of ultraviolet light and riboflavin (vitamin B2) to make the collagen fibers in the cornea closely connected like "hand in hand".

Applicable population:

①The diagnosis of progressive keratoconus, corneal edge degeneration, continuous corneal thinning, astigmatism continued to deepen;

②Born with thin corneal thickness and high myopia, the residual corneal support after laser surgery is insufficient;

③The corneal morphology was irregular, and there was a tendency of corneal protrusion;

④Corneal stability decreased and power regressed after previous refractive surgery.

2. scleranoscope

Scleranoscope is a large-diameter high oxygen permeable rigid contact lens designed for irregular corneal eye disease. Different from ordinary contact lenses and conventional RGP, the lens has a larger diameter, completely covers the whole cornea, the support point falls on the white sclera of the eye, and a tear buffer layer is retained between the lens and the diseased cornea, which does not directly rub and compress the convex and deformed cornea.

Applicable population:

①Mild, moderate and severe keratoconus, frame glasses corrected vision is not ideal;

②Wearing ordinary RGP hard lenses has a strong foreign body feeling and cannot be tolerated;

③Irregular astigmatism caused by corneal trauma scar after corneal transplantation;

④Moderate to severe dry eye and recurrent corneal epithelial injury;

⑤All kinds of complex corneal malformations, the effect of conventional optical correction scheme is poor