Our aim is, to treat patient as early as possible, to avoid entering Stage IV. Usually this succeeds, if the methods mentioned above are used.
In stage IV - if the patient has waited too long and the posterior layers are scarred or overstretched - a DALK is no longer possible. Then a PKP must be performed. In these cases we implant the Krumeich Ring to minimize irregular astigmatism, which is common in PKP
A further procedure to stop keratoconus - aside from CKT (s.a.) - is cross-linking (CXL) with Riboflavin. This procedure rarely improves visual acuity but freezes the situation of the cone such as presented. Prerequisite of CXL is thickness of more than 400µm over the whole cornea. It can therefore only be used for Stage I+II.
Costs of CKT are not reimbursed by the social insurance companies. DALK and PKP are standard procedures which are reimbursed. Refractive Epi will not be overtaken by social, but by private insurances. Riboflavin cross-linking will be paid by some social and private insurances.