الفهرس 
Introduction and Aim of the work……………...Only 14 pages are availabe for public view
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Abstract
Keratoconus is a progressive disorder of non inflammatory corneal thinning in which the stroma assumes a conical shape, leading to myopia and irregular astigmatism, and mild-to-marked impairment in quality of vision.
The condition usually affects both eyes, although asymmetric involvement may exist. Onset is typically at puberty with progression until the third or fourth decade of life; however, the condition may commence later in life or arrest at any age.
The refractive error caused by the ectatic cornea is managed according to the stage of keratoconus. In early keratoconus spectacles may be effective in restoring vision. As the disease progress RGP contact lens would be our choice, by time the cornea becomes more conical and contact lenses no longer fits on ectatic cornea or provides acceptable visual acuity. New methods as intracorneal stromal ring segments (INTACS), which are ocular inserts in the corneal stromal causing central flattening and thus helps regaining of the contact lens tolerance and overcome the need for penetrating keratoplasty.
Intralamellar Keratoplasty is a tectonic surgery adding stromal tissue to ectatic cornea which helps regaining contact lens tolerance.
A new technique of collagen crosslinking by the photosensitizer riboflavin and UVA similar to photopolimerization has been developed. Extensive experimental studies showed a significant increase in corneal rigidity by approximately 70% in untreated versus treated corneas after collagen crosslinking.
Thus stiffening the cornea with collagen crosslinking may stop the progression of the disease and turn it to form fruste.
Collgen crosslinking is combined with INTACS in attempt to stop progression after INTACS implantation.
DLKP (Deep anterior lamellar keratoplasty) is useful in cases of anterior scarring with healthy endothelium and descemet’s membrane which is associated with better results and less rejection
Conclusion:
Crosslinking treatment of keratoconus is a very promising new method of treating keratoconus. At the present stage of knowledge, the treatment should only be performed in patients with documented progression of keratoconus.
INTACS surgery is a reversible, less invasive procedure with great results in treatment of moderate keratoconus ; it helps regaining contact lens tolerance. It may be combined with collagen crosslinking to stabilize corneal tissue after surgery thus overcome or at least delay the need for penetrating keratoplasty.