Alqudah Noor
Division of Ophthalmology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Med Hypothesis Discov Innov Ophthalmol. 2024 Jul 1;13(1):44-54. doi: 10.51329/mehdiophthal1493. eCollection 2024.
Keratoconus (KCN) is characterized by gradual thinning and steepening of the cornea, which can lead to significant vision problems owing to high astigmatism, corneal scarring, or even corneal perforation. The detection of KCN in its early stages is crucial for effective treatment. In this review, we describe current advances in the diagnosis and treatment of KCN.
This narrative review focuses on recent advancements in the diagnosis and treatment of KCN, especially evolving approaches and strategies. To ensure the inclusion of the most recent literature, relevant publications discussing advanced imaging techniques and treatment options for KCN were extensively gathered from the PubMed/MEDLINE and Google Scholar databases. The following index terms and keywords were used for the online search: keratoconus, diagnosis of keratoconus, advances in the diagnosis of keratoconus, topography or tomography, anterior segment optical coherence tomography, treatment of keratoconus, advances in the treatment of keratoconus, collagen crosslinking, intrastromal ring, keratoplasty, and new techniques in keratoconus.
Various screening methods such as corneal topography, tomography, anterior segment optical coherence tomography, and assessment of corneal biomechanics have been developed to identify KCN in its early stages. After diagnosis, KCN management focuses on preventing disease progression. Corneal collagen crosslinking is a minimally invasive treatment that can slow or stop the progression of the condition. Recent research has also explored the use of copper sulfate eye drops (IVMED-80) as a noninvasive treatment to prevent the progression of KCN. Current treatment options for visual improvement include scleral lenses, intracorneal ring segments, corneal allogeneic intrastromal ring segments, and deep anterior lamellar keratoplasty. Recently, novel alternative procedures, such as isolated Bowman layer transplantation, either as a corneal stromal inlay or onlay, have demonstrated encouraging outcomes. Artificial intelligence has gained acceptance for providing best practices for the diagnosis and management of KCN, and the science of its application is contentiously debated; however, it may not have been sufficiently developed.
Early detection and advancements in screening methods using current imaging modalities have improved diagnosis of KCN. Improvement in the accuracy of current screening or diagnostic tests and comparison of their validities are achievable by well-designed, large-scale, prospective studies. The safety and effectiveness of emerging treatments for KCN are currently being investigated. There is an ongoing need for studies to track progress and evaluate clinicians' knowledge and practices in treating patients with KCN. Artificial intelligence capabilities in management approach considering the currently available imaging modalities and treatment options would best benefit the patient.
圆锥角膜（KCN）的特征是角膜逐渐变薄和变陡，由于高度散光、角膜瘢痕甚至角膜穿孔，可导致严重的视力问题。在圆锥角膜的早期阶段进行检测对于有效治疗至关重要。在本综述中，我们描述了圆锥角膜诊断和治疗的当前进展。
本叙述性综述重点关注圆锥角膜诊断和治疗的最新进展，尤其是不断发展的方法和策略。为确保纳入最新文献，从PubMed/MEDLINE和谷歌学术数据库广泛收集了讨论圆锥角膜先进成像技术和治疗选择的相关出版物。在线搜索使用了以下索引词和关键词：圆锥角膜、圆锥角膜的诊断、圆锥角膜诊断的进展、地形图或断层扫描、眼前段光学相干断层扫描、圆锥角膜的治疗、圆锥角膜治疗的进展、胶原交联、基质内环、角膜移植术以及圆锥角膜的新技术。
已经开发了各种筛查方法，如角膜地形图、断层扫描、眼前段光学相干断层扫描和角膜生物力学评估，以在早期阶段识别圆锥角膜。诊断后，圆锥角膜的管理重点是预防疾病进展。角膜胶原交联是一种微创治疗方法，可以减缓或阻止病情进展。最近的研究还探索了使用硫酸铜滴眼液（IVMED - 80）作为预防圆锥角膜进展的非侵入性治疗方法。目前用于改善视力的治疗选择包括巩膜镜、角膜内环片、角膜同种异体基质内环片和深板层角膜移植术。最近，新型替代手术，如单独的Bowman层移植，作为角膜基质嵌入或覆盖物，已显示出令人鼓舞的结果。人工智能已被认可为提供圆锥角膜诊断和管理的最佳实践，其应用科学存在争议；然而，它可能尚未得到充分发展。
使用当前成像模式的早期检测和筛查方法的进展改善了圆锥角膜的诊断。通过精心设计的大规模前瞻性研究，可以提高当前筛查或诊断测试的准确性并比较其有效性。目前正在研究圆锥角膜新兴治疗方法的安全性和有效性。持续需要进行研究以跟踪进展并评估临床医生治疗圆锥角膜患者的知识和实践。考虑到当前可用的成像模式和治疗选择，人工智能在管理方法中的应用将使患者受益最大。
