[Therapeutic Options in Keratoconus].

A recent epidemiology study revealed that prevalence of keratoconus was much higher than previously assumed. Therefore, it is no longer deemed an "orphan disease", as it has a relevant socioeconomic impact on the healthcare system. One of the most important risk factors for developing keratoconus is chronic eye rubbing which, apart from other known risk factors such as atopy or Down's syndrome, is the only modifiable factor. Informing the patient and offering behavior modifying therapies seems to be essential. Further therapeutic options regarding improvement of visual function include the wearing of glasses and the fitting of rigid gas permeable contact lenses and implantation of intrastromal corneal ring segments or phakic intraocular lenses. Corneal crosslinking (CXL) has been proven to be a highly effective and safe procedure in keratoconus cases showing disease progression. Significantly fewer corneal transplants were performed in this indication following the introduction of CXL. Recent studies reevaluated a combination of photorefractive keratectomy, which has been contraindicated until recently for patients with primary corneal ectasia with CXL, reporting a positive visual refractive outcome and stability of keratoconus. Still, penetrating keratoplasty is the gold standard of surgical treatment for end-stage keratoconus, whereas recently lamellar procedures have gained higher importance.