Keratoconus is one of the most frequently encountered types of ectatic dystrophic degeneration of the cornea. It generally has its onset in adolescence, is bilateral, asymmetric and characterized by irregular astigmatism associated with thinning of the cornea. In approximately 20% of cases keratocornus requires lamellar and/or perforating keratoplasty, depending on the stage of the condition and the patient’s compliance with contact lenses. Technical advances in ophthalmology and widespread use of corneal topography and pachymetry in refractive surgery have revealed a considerable number of undiagnosed cases of keratoconus. In our experience, its real incidence is far higher (1 in 450 patients) than that reported in the literature (1 in 2000 patients). In Italy and elsewhere in Europe, keratoconus is the primary reason for corneal transplantation and has raised concern about its social and medical impact owing to the increasing number of younger patients seeking treatment. Advanced pathogenetic-based therapeutic options such as corneal crosslinking now permit prompt diagnosis and adequate treatment based on correct clinico-diagnostic staging of the condition, its natural history, compliance with contact lenses, patient age and quality of life. There are three basic approaches to treatment: prevention or slowing down of progression during the refractive stage; correction or reduction of the refractive defect of aberrations; replacement of the ectatic cornea in the advanced stage in keratocornus recalcitrant to lens treatment. This review article describes current therapies according to the stage of the disease and provides useful practical guidelines derived from observation and treatment of thousands of cases from the authors’ clinical series.

Il cheratocono rappresenta la più comune e frequente distrofia “ectasica” della cornea a carattere degenerativo. Generalmente la malattia ha esordio in età puberale, è bilaterale, asimmetrica ed è contraddistinta dalla presenza di una astigmatismo irregolare associato a riduzione dello spessore corneale. In circa il 20% dei casi il cheratocono evolutivo necessita di una cheratoplastica lamellare e/o perforante a seconda dello stadio e della compliance del paziente alle lenti corneali. I progressi tecnologici a servizio dell’Oftalmologia e l’uso quasi routinario della topografia e della pachimetria corneale in chirurgia rifrattiva hanno messo in luce una grande quantità di cheratoconi non ancora diagnosticati pertanto, nella nostra esperienza, l’incidenza della malattia è realmente ben superiore (1 caso su 450 pazienti) rispetto a quella riportata in letteratura (1 caso su 2000). Il cheratocono in Italia ed in Europea è la prima causa di trapianto corneale e ciò desta non poche preoccupazioni in particolare per l’impatto sociale e sanitario dovuto al coinvolgimento di pazienti sempre più giovani. Alla luce delle nuove possibilità terapeutiche ad “indirizzo patogenetico” come il Crosslinking corneale, oggi non si può accettare né una diagnosi tardiva né una scelta terapeutica non adeguatamente ponderata la quale deve essere basata sulla corretta stadiazione clinico-strumentale della malattia, sulla sua evolutività, sulla compliance alle lenti a contatto, sull’età del paziente e sulla sua qualità di vita. La moderna terapia del cheratocono è diretta in tre direzioni principali: prevenzione o rallentamento della progressione in fase rifrattiva; correzione o riduzione del difetto rifrattivo e delle aberrazioni; sostituzione della cornea ectasica in fase avanzata in pazienti non suscettibili di miglioramento contattologico. Questa Review si propone di descrivere le attuali possibilità terapeutiche del cheratocono basate sullo stadio della malattia fornendo utili e pratiche linee guida basate sulla osservazione e sul trattamento di migliaia di casi da parte degli Autori.

Caporossi, A., Mazzotta, C., Baiocchi, S., Balestrazzi, A., Caporossi, T. (2008). Keratoconus Therapeutic Guidelines based on staging: from CrossLinking to Penetrating Keratoplasty : Linee guida basate sullo staging del cheratocono: dal cross-link corneale alla cheratoplastica. MINERVA OFTALMOLOGICA, 50(2), 43-58.

Keratoconus Therapeutic Guidelines based on staging: from CrossLinking to Penetrating Keratoplasty : Linee guida basate sullo staging del cheratocono: dal cross-link corneale alla cheratoplastica

MAZZOTTA C;Baiocchi S;Balestrazzi A;
2008-01-01

Abstract

Keratoconus is one of the most frequently encountered types of ectatic dystrophic degeneration of the cornea. It generally has its onset in adolescence, is bilateral, asymmetric and characterized by irregular astigmatism associated with thinning of the cornea. In approximately 20% of cases keratocornus requires lamellar and/or perforating keratoplasty, depending on the stage of the condition and the patient’s compliance with contact lenses. Technical advances in ophthalmology and widespread use of corneal topography and pachymetry in refractive surgery have revealed a considerable number of undiagnosed cases of keratoconus. In our experience, its real incidence is far higher (1 in 450 patients) than that reported in the literature (1 in 2000 patients). In Italy and elsewhere in Europe, keratoconus is the primary reason for corneal transplantation and has raised concern about its social and medical impact owing to the increasing number of younger patients seeking treatment. Advanced pathogenetic-based therapeutic options such as corneal crosslinking now permit prompt diagnosis and adequate treatment based on correct clinico-diagnostic staging of the condition, its natural history, compliance with contact lenses, patient age and quality of life. There are three basic approaches to treatment: prevention or slowing down of progression during the refractive stage; correction or reduction of the refractive defect of aberrations; replacement of the ectatic cornea in the advanced stage in keratocornus recalcitrant to lens treatment. This review article describes current therapies according to the stage of the disease and provides useful practical guidelines derived from observation and treatment of thousands of cases from the authors’ clinical series.
2008
Caporossi, A., Mazzotta, C., Baiocchi, S., Balestrazzi, A., Caporossi, T. (2008). Keratoconus Therapeutic Guidelines based on staging: from CrossLinking to Penetrating Keratoplasty : Linee guida basate sullo staging del cheratocono: dal cross-link corneale alla cheratoplastica. MINERVA OFTALMOLOGICA, 50(2), 43-58.
File in questo prodotto:
File Dimensione Formato  
1609-minerva guidelines MOF.pdf

non disponibili

Descrizione: Articolo
Tipologia: PDF editoriale
Licenza: NON PUBBLICO - Accesso privato/ristretto
Dimensione 221.01 kB
Formato Adobe PDF
221.01 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11365/1181197