C3R - Treatment of Keratoconus

What is Keratoconus?

This is a disease of the eye where the front surface of the eye, called Cornea, becomes weak, leading to progressive thinning and stretching which gradually progresses. Gradually, the Cornea bulges forwards, leading to an irregular cone shape. This causes distortion and blurring of the image formed by the cornea. Usually this disease is bilateral, though the severity may vary between the two eyes.

What are the causes of Keratoconus?

It is a disease of an uncertain cause with an unpredictable course. Risk factors include - Eye rubbing, Family history, Genetic predisposition , Connective tissue disease. It can not be inherited.

What are the symptoms of Keratoconus?

An early symptom of Keratoconus is a change in the spectacle power. When the disease progresses, vision deteriorates and may not improve with spectacles. It also causes distortion in vision with multiple images, streaking and sensitivity to light.

What is the treatment for Keratoconus?

The methods of treatment include –

1. Use of Contact Lenses: Early Keratoconus can be managed by giving rigid Contact Lenses to the patient which correct the irregularity of the cornea and provide better quality of vision. However, the disadvantage of contact lenses is that, in severe cases, optimal fit is not achieved and rigid lenses are more difficult to wear.
2. C3R (Corneal Collagen Cross linking with Riboflavin): This is a permanent treatment and is the only way to stop the progression of Keratoconus. It is based on collagen cross-linking with ultra-violet A (UVA, 365 nm) and Riboflavin (vitamin B2, a photo sensitizing agent). This changes the intrinsic biomechanical property of the cornea, increasing its strength by almost 300%. This increase in corneal strength has shown to arrest the progression of Keratoconus and in some cases, it can reverse the Keratoconus completely.
3. Cornea Transplant: This is a surgical treatment, which is reserved for advance cases of Keratoconus, where the vision can not be improved with glasses or contact lenses. Here the central portion of the cornea is removed and replaced with a donor cornea of similar size. Since there is high possibility of complications & graft rejection,this surgery is reserved for selected cases.
4. Intacs: These are acrylic rings inserted in the corneal stroma to decrease corneal irregularity in cases of Keratoconus. They can improve uncorrected vision without contact lenses. These can also be combined with C3R.

How C3R is done?

To perform C3R treatment, the eye is anaesthetized with the help of local anaesthetic eye drops. Then, Riboflavin eye drops are put every 2 minutes for half an hour. Thereafter, the eye is exposed to desired ultraviolet exposure with a specialized machine. During the treatment also, Riboflavin drops are put every five minutes. After the treatment, there is no need to patch up the eye.

Is there a need for hospitalization after the treatment?

There is no need for hospitalization after the treatment. However, you will need to go home and take rest for 2-3 days.

When can I return to work?

Your vision will remain blurred for 2-3 days after the treatment. So, you can work after 3 days.

When will my vision improve after the procedure?

Your vision will gradually start improving after a month and your contact lens fitting may change during this time. These changes continue even upto one year after the treatment.

Will I still need glasses and contact lenses after the treatment?

Though this treatment will reduce cylindrical power by couple of diopters and will improve the quality of your vision but you will still require corrective glasses or contact lenses, as the case maybe, though their power will change.

What are the advantages of C3R treatment?

This treatment is know to stop progression of keratoconus and in early cases may even cure the disease.

What are the complications of the procedure?

As per the literature available at present there are no known complications of the procedure. However the problems associated with the procedure are transient blurring of vision & slight pain and discomfort for initial 2 days.