Issue 6/2026
Kirova, Т., Genchovski,, Р., Kalaidzhiev, А.
Department of Eye Diseases, Ear, Nose and Throat Diseases and Oral Surgery,
Military Medical Academy – Sofia
Introduction: Keratoconus is a progressive, bilateral (often asymmetric) ectatic corneal disease, leading to thinning, cone-shaped deformation and increasing irregular astigmatism with worsening vision. Clinical picture: The clinical picture of keratoconus develops gradually – from discrete refractive changes to severe corneal deformation with significant visual impairment, figure 1. Early recognition of symptoms and timely referral to a specialist allow for the application of stabilizing methods and the prevention of severe complications. Diagnosis and treatment: The modern approach is shifting towards early (subclinical) diagnosis through corneal tomography, epithelial mapping (AS-OCT) and biomechanical assessment, as well as early stabilization of progression through corneal collagen cross-linking (CXL). In parallel, functional rehabilitation methods are being developed – scleral lenses, intrastromal ring segments (ICRS), tissue “additive” techniques such as CAIRS, combined procedures (e.g. CXL + ICRS/CAIRS, topographically directed surface ablations + CXL) and lamellar/perforating keratoplasty in advanced cases. Conclusion: This review presents the key new diagnostic concepts, practical criteria for progression and modern therapeutic strategies aimed at personalized treatment.
Key words: keratoconus, corneal tomography, epithelial map, biomechanics, CXL, accelerated CXL, ICRS, CAIRS, DALK.
Address for correspondence:
Dr. Tanislava Kirova, MD
VMA – Sofia
1606, Sofia
3, „Georgi Sofiyski“, Str.