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    Thinking outside the cone: Over, above standard approach

    Scenarios of keratoconus, management highlight ways to devise treatment ‘recipes’

    Dr. GulaniIn this continuation that presents more scenarios of keratoconus and their management, let’s first briefly recap the discussion in the previous “Gloves off with Gulani” column, “Thinking outside the cone: Keratoconus as a refractive surgery,” as well as some principles we covered during the case discussion (Keratoconus: Thinking outside the cone).

    When we consider a condition such as keratoconus as a refractive disorder, the mindset then shifts from salvaging the eye to actually bringing it to visual excellence despite the cone. We talked about various modalities, concepts, and classification systems that I have discussed over two decades, and we reviewed some case scenarios in the previous column.

    Therefore, I want to approach every case of keratoconus with the mindset that the eye can possibly reach the best visual outcome by using all the available technologies and techniques, performed singly or in staged combinations, to the patient’s best advantage. All images are courtesy of Arun C. Gulani, MD. 

    Case scenarios

    Figure 1

    In these case scenarios, I will quickly review placement of Intacs segments (Addition Technology) using the Gulani-Donnenfeld concept of entry into the cornea at the 12 o’clock position, although the segment placement still can be on the steep axis at any orientation.

    Arun C. Gulani, MD
    Dr. Gulani is director of refractive surgery and chief, cornea & external disease, as well as assistant professor, department of ...

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