The Best ophthalmologist for the treatment of keratoconus in Egypt

Who is the best corneal surgeon in Egypt?

Dr. Ashraf Soliman corneal and laser refractive surgery, cataract and glaucoma consultant is considered one of the best corneal surgeons in Egypt and the Middle East. His expertise, knowledge, and use of state-of-the-art technology allows for impressive results in the treatment and outcome of keratoconus surgery, and the best visual results the patient can experience. 


Diagnosing and investigating keratoconus

First, Dr. Ashraf Hassan Soliman, the best surgeon for the treatment of keratoconus in Egypt, starts by complete and thorough examination of the eye using a high precision slit lamp to identify advanced cases, which suffer from severe conical bulging of the cornea, the appearance of parallel lines within its stroma. This preliminary examination is followed by a series of corneal imaging using state of the art technology and machines, which create a topographical map of the anterior and posterior surfaces of the cornea.  These images give a very accurate impression of the state of the corneal bulge, cone position, corneal thickness, and mapping of each point on the corneal surface. In addition, ultrasound waves can also be used to assess the thickness of the cornea to further confirm the results. Evidence based medicine has allowed ophthalmologists to set the reference thickness of 500 micrometers for normal corneas, stating that thickness below that denotes high suspicion of keratoconus.

Familiarize yourself with the term keratoconus.

It is a disease that affects many age groups but namely the teenage and young adult groups, and has shown an increased incidence rate in Egypt over the last few decades. In the following article we will discuss most aspects that are important for any person to know about this serious condition, its symptoms, methods of management, and the best ophthalmologist or eye doctor in Egypt to manage keratoconus. 

What is keratoconus? 

this condition is one of the most popular chronically or slowly progressive ocular conditions that takes years to affect and actually impair a person’s vision. In this condition the cornea, the clear window at the front of the eye loses its natural spherical contour, and becomes thinned out, bulging out at weak points and assuming a conical shape, of varying steepness and position, or a more generalized ball shaped bulge affecting a large surface of the cornea. This abnormality of shape and contour affects the bending of light rays at the corneal interface, causing irregular bending and defocus of these rays when they fall onto the retina, leading to drop of visual clarity and acuity. The condition affects one or both eyes with varying degrees, and the average age of affection is between 15 -25 years.

what causes keratoconus?

Numerous reasons have been implicated, and some maybe primary of secondary to a preexisting eye condition that we sometimes inevitably do, for example excessive rubbing of the eyes and the infections caused by that, misuse and abuse of contact lenses. Some factors maybe environmental, genetic or familial that have been proven to increase the risk of developing the condition. In addition, excessive unprotected exposure to sunlight, car exhaust and pollution, and constant eye rubbing have also been implicated. Also, the misuse of poor-quality contact lenses has also been added to the predisposing factors. It may also be a secondary complication of spring catarrhal in some cases. 

  Research has shed light that a deficiency of certain building enzymes within the corneal stroma, and lack of antioxidants are strong factors when considering the pathology of the condition.   The wear and tear that is constantly repaired by these enzymes is slowed down, causing excessive accumulation of diseased collagen fibers and oxygen free radicles, leading to weakening of the corneal stromal bridges, and hence weakness and forward bulge of the cornea.

What are the cure rates of keratoconus?

Fortunately, keratoconus has a high cure rate, depending on the proper management and use of advanced technology that allow for proper wound healing whether after a keratoplasty or ring implantation where the patient markedly improves over a short period of a few weeks up to a month at the most. Femtosecond laser assisted surgeries have the highest and the fastest healing rates with the best final visual outcomes when compared to traditional treatment modalities.

What are the treatment options for keratoconus?

There are five main lines of treatment depending on the severity of the case and the results of examination of imaging. These are 

  1. Glasses or contact lenses, this is reserved for early cases as a primary form of treatment, and is usually a temporary treatment that does not stop disease progression or advancement. 
  2. Corneal collagen cross linking: this procedure uses ultraviolet light rays and concentrated vit B2 eye drops to create and strengthen the interconnecting bridges between the collagen fibers in the corneal stroma, making it stronger and less liable to bulge. The vitamin B2 drops are instilled onto the eye over a period of 30 minutes, this is followed by further 30 minutes of ultraviolet exposure. 
  3. Other popular modalities of treatment include intracorneal ring implantation, these semicircular devices made of PMMA are inserted into tracks created within the stroma of the diseased cornea and help to restore visual clarity and acuity by flattening the cones and increasing corneal thickness therefore creating a smoother refractive surface and regular light refraction onto the retina.
  4. Corneal transplantation: if the cornea is severely thinned out or damaged you might need to have it partially or fully replaced by donor tissue. This surgery restores the natural anatomy of the cornea and may provide best visual outcomes for some cases. This surgery carries the best and most accurate outcomes when performed by femtosecond laser, when it has the safest and fastest healing profile. The laser can be used to create micro air bubbles that facilitate the separation of the corneal layers are very accurate depths into the stroma, or making very precise full thickness incisions in both the donor and recipient beds for best wound coaptation.  The advantage of using this technology is that it does not need general anesthesia, or a hospital stay, and usually takes about 40-45 minutes to complete. 
  5. Some cases may also benefit from surg=face laser ablation and it is upon the surgeon’s discretion and experience to decide the best course of action for the patient.

Not all keratoconus patients have the same condition or follow the same treatment protocol, or respond to the same treatment modality, each treatment option is specifically tailored according to the presented case 

Post-operative Recommendations after keratoplasty:

Patients are advised to strictly adhere to the doctor’s orders after keratoplasty to ensure best healing and highest visual outcomes. Some of these recommendations include 

  1. Avoid excessive physical exertion, lifting heavy weights or intense exercise.
  2. Avoid excessive heat especially near the eye
  3. Avoid rubbing the eye or getting any shampoo or soap into it 
  4. Strictly adhering to post-operative drops schedule to avoid any infection that could compromise the success
  5. Avoid excessive air currents for at least a month

What are the complications of keratoconus?

In the event of delayed or missed diagnosis of the condition some complications include 

  1. Rapid detrimental changes in the shape of the corneal topography
  2. burring of both near and far vision
  3. dark haloes around light especially at night
  4. rapid changes in collagen transparency leading to opacities and scarring in the cornea

these changes can occur in one eye or both but at varying intensities, highlighting the need for prompt and proper diagnosis and management.

What is the cost for keratoplasty surgery in Egypt?

This will vary according to numerous factors depending on the type of surgery and the technology used, in addition to the doctor’s skill, experience and reputation in using the updated technology in corneal transplant. it also depends on the hospital chosen by the doctor; therefore, it is important for the patient to ask about the prices and technology before embarking on the treatment journey. 

Frequently asked questions:

Complete resolution is impossible owing to the obscure nature of the disease, however marked improvement of visual acuity and stabilizing the condition from deterioration are the aims of the surgery.

Genetics and hereditary factors play a rather essential role in the development of the condition especially in children, but with varying degrees of severity. That is why ophthalmologists strongly recommend regular and routing examination of children’s eyes to properly diagnose and detect the condition and therefore early treatment and prevention of complications.

It does not cause blindness in the sense that we know it, but it can markedly cause a progressive drop of visual acuity that may affect daily activities, that is why it is important to receive treatment at the proper stage of the disease.

There is no evidence that physical exercise causes a progression or regression of keratoconus.

Doctors do not recommend Lasik for keratoconus patients, but vision can be markedly improved using the available treatment options. After treatment of the condition, and ensuring that the corneal topography has improved the doctor will recommend the best course of action to correct any residual error of refraction according to your case.