Corneal Ectasia: prevention and management

Francois Malecaze MD commenced the session with an update on current research into the genetics of keratoconus. Dr Malecaze noted that forme fruste keratoconus is one of the major causes of post-LASIK corneal ectasia and the condition may be due to genetic factors in the majority of cases. Identification of the gene or genes responsible for keratoconus might lead to the development of blood tests that would enable surgeons to identify patients at risk of keratectasia before any clinical signs of keratoconus are evident. Such discoveries might also lead to better treatments of the condition “Genetics are an elegant strategy to elucidate the phenomena underlying the corneal deformation and consequently could lead to new therapeutic strategies aimed at slowing down its evolution and avoiding corneal grafting,” he said. Topography has proved to be a valuable tool in detecting keratoconus suspects, enabling clinicians to identify warning signs such as moderate inferior steepening. However, topography does not enable surgeons to distinguish between early-stage keratoconus and “pseudo-keratoconus”, that is, an irregular cornea that is not undergoing progressive change.A more definitive diagnosis might be afforded by a blood test for keratoconus genes. “Detecting forme fruste keratoconus is a major problem when screening patients for refractive surgery. Improving the diagnostic criteria will also allow for better topographical characterisation of the condition,” he added.