1. Keratoconus diagnosis and treatment Sedaghat M.R M.D MASHAD EYE RESEARCH CENTER Khatam-al-Anbia Hospital

6. Incidence of keratoconus 0.03% – 0.05 % for keratoconus 6 % - 17% for form fruste keratoconus?

27. Keratoconus course

28. Evaluation and diagnosis of keratoconus History and family history Follow up evaluation Slit -lamp exams Keratoscopy- Keratometry Corneal thickness - pachymetry Topography - Orbscan –Pentacam

29. Keratoscopy

30. What is topography?

31. What is topography?

33. KCN clinical classification

38. Keratoconus suspect inferior steepening

40. Keratoconus pattern: Inferior steepening without bowtie pattern specially more prominent temporally

42. Keratoconus pattern: asymmetrical bow tie (AB) & inferior steepening(IS)

44. Keratoconus pattern: asymmetrical bow tie (AB) & superior steepening(SS)

46. Keratoconus pattern: Central keratoconus central unusual steepening without bow tie

48. Keratoconus pattern: Central steepening, superimposed with asymmetrical bowtie- slightly irregular astigmatism asymmetrical central hourglass

50. Globus topographic type of KCN

52. Keratoconus pattern: Symmetic(SB) /asymmetric bow tie (AB) & (SRAX)

54. Keratoconus pattern: asymmetrical bow tie & skewed radial axes (AB/SRAX)

56. Keratoconus pattern: symmetrical bow tie & skewed radial axes (AB/SRAX)

62. Keratoconus course With cross-linking Without cross-linking

69. X - Linking and cornea?

71. Increase in mechanical stiffness of the corneal by cross - linking Eberhard Spörl, TU Dresden

73. X - Linking and cornea?

74. X-linking

75. UVA 370 nm Irradiance 3 mW/cm 2 for 30 min Dose of 5.4 J/cm 2

76. Treatment procedure

78. UV-X SYSTEM Automated timing and intensity control Intensity calibration for safe use Easy mounting and positioning Transportable in compact case

80. Rigid gas permeable (RGP) contact lenses

85. Modified Melles technique-DALK

86. Modified Melles technique-DALK after 2w

87. Modified Melles technique-DALK after 1.5 m

88. 6 m after DALK big bubble technique

92. The ring segments have a prism format; the flat posterior surface is implanted facing the corneal endothelium FERRARA ring

94. Mechanism of Action Steepest Meridian

96. 250  / 210° 250  / 90° 200  /120°

98. FICR: male 20 yrs OS preoperative exams Subj ref: plano -6 × 160 Cyclo ref: overcylinder KR average: 56.99 D Cyl of KR: -11.27 D × 162 AL : 24.15mm AC depth: 4.17 mm CCT:422 μ UCVA: 3/10 BSCVA=5/10

99. FICR: male 20 yrs OS preoperative exams

101. FICR: male 20 yrs OS postoperative exams Subj ref: plano Cyclo ref: -0.25 -3.5 × 90 KR average: 48.22 D Cyl of KR: -6.56 D × 37 UCVA: 8/10 BSCVA=8/10

102. FICR: male 20 yrs OS topographic change after FICR

103. FICR: male 20 yrs OS topographic change after FICR Subj ref: plano Cyclo ref: -0.25 -3.5 × 90 KR average: 48.22 D Cyl of KR: -6.56 D × 37 UCVA: 8/10 BSCVA=8/10 Subj ref: plano -6 × 160 Cyclo ref: overcylinder KR average: 56.99 D Cyl of KR: -11.27 D × 162 UCVA: 3/10 BSCVA=5/10

105. Toric artisan: male 23 yrs OD preoperative exam Subj ref: -18.5 -5 × 110 (0.5) Cyclo ref: -16.75 - 6.25 × 6 KR average: 56D Cyl of KR: 6 × 10 AL : 26.66mm AC depth: 4.39mm CCT:408 μ Artisan IOL: - 17 – 5.5 × 18

106. Toric artisan: male 29 yrs OD preoperative exam

107. Toric artisan: male 23 yrs OD preoperative exam

108. Toric artisan: male 23 yrs OD preoperative exam

109. Toric artisan: male 23 yrs OD IOL calculation

110. Toric artisan: male 23 yrs OD preoperative exam