Case history of ophthalmology: keratoconus

Recently, cases of the appearance of keratoconus-dystrophic corneal disease, which is characterized by bilateral progressive progression of the cornea in front with thinning of the central parts, have become more frequent. The process ends with scarring of the cornea and in the advanced stages it is not difficult to diagnose. When viewed "in profile" it becomes clear that the cornea acquires the appearance of a glass "cap", horn-like inclined downwards. Vision deteriorates sharply due to the high abnormal astigmatism and opacity of the cornea developing at the apex of protrusion.

At the same time, the debut of this disease is not always obvious, "blurred" symptoms, and the first manifestation of it is most often progressive disease and incorrect myopic astigmatism with a decrease in maximum visual acuity in conditions of optimal correction with spherical lenses. Characteristic is an increase in visual acuity when viewed through the diaphragm, which cuts the light scattering rays and emits part of the cornea with a uniform profile approaching the spherical. Optimum high correction makes it possible to get hard contact lenses, although in the early stages with this can handle even more comfortable soft lenses. Learn more about this disease in the article "The history of the disease in ophthalmology keratoconus."

An important distinguishing feature of this disease is its appearance and progression in later than "school" myopia, the age and asymmetric refraction of the two eyes by the rapid increase in anisometropia. Asthenopic complaints associated with increased requirements for the operation of the accommodative apparatus are also characteristic because of the appearance of astigmatism and different refraction of the eyes. The described symptoms make it possible to suspect the development of keratoconus and serve as an indication for conducting ophthalmometry (or keratometry) and biomicroscopy under a slit lamp. With ophthalmometry, attention is drawn to the distortion and decrease in the value of test stamps, the radius of curvature of the cornea to 7 and less than millimeters, an increase in its refractive power to 48 Dpt and more. Biomicroscopy with the use of a thin optical section indicates a tendency to local protrusion of the cornea, often to the bottom, sometimes paracentral. The cut tends to rapid thinning in the area of ​​the apex of the keratoconus with a characteristic stretching of the epithelium, which, in the first place, suffers from a defect and rupture of the Bowman shell. Then there are faults and folds of the stroma and Descemet's shell with the formation of a typical radiance - the streaks of Vogt. The change in the posterior profile of the cornea inevitably leads to local loss of endothelial cells and the entry of watery moisture into the cornea. As a result, it appears clouding from local to total edema, called the dropsy of the cornea or acute keratoconus.

Despite the large number of theories about the history of the disease in ophthalmology, the cause of the development of keratoconus is not clear. Therefore, pathogenetic therapy does not exist. At the initial stages, supportive dystrophic therapy is carried out with the appointment of taufon, derinata, vitasik preparations against the background of correction by soft and hard contact lenses. The development of acute keratoconus is an indication for end-to-end keratoplasty. Recently, doctors recommend in the initial stages of keratoconus to perform a combined operation, combining excimer laser keratectomy with phototherapeutic keratectomy, stimulating the "corset" properties of the Bowman shell and cornea. However, although the first results are encouraging, these methods still require verification by time.

"Phacogenic" myopia

By analogy and ophthalmology with phacogenic glaucoma, which develops due to cataracts, swelling, lysis or subluxation of the lens, it is necessary to isolate and phacogenous myopia. In life, we meet this variant and the history of the disease much more often than it seems. Any ophthalmologist knows that people with cataracts are more likely to see with negative glasses. And often these people were not short-sighted in their youth. The cause of increased refraction may be hydration, hydration, vacuolization of the lens in the process of cataract development. Particularly significantly changes its refractive power, when this process affects the densest and most compact part of it - the core. Therefore, nuclear cataracts often debut with the appearance or intensification of the disease. Some people even boast that the doctor writes out weaker reading glasses, and they can already read without glasses at all. Others come to the doctor with complaints of vision impairment, often first one eye. The doctor picks up the glasses and reassures the person that there is nothing terrible, just a fifty-sixty-year-old man has appeared and is progressing myopia. There are cases when, during a rapid change of glasses during the year, malignantly progressive (by 2-4pts!) Disease was diagnosed and scleroplasty was recommended! Of course, with the advent of intensive computerization of the population, we are now beginning to face, for the first time, an increase in refraction in people even older than 35-40 years who are engaged in intense work at close range. And yet it is not typical. Therefore, any progression of the keratoconus in the fifth to sixth and more than ten years, especially if as the corrective negative glass decreases the maximum visual acuity is a reason to suspect the development of cataracts and conduct a biomicroscopic examination. When confirming the diagnosis of cataract and phacogenic keratoconus, the usual installation of vitamin therapy is shown with an explanation to the person about the causes of myopia development. Now we know what a history of the disease exists in ophthalmology keratoconus.