Surgical treatment of keratoconus at the turn of the 20th century

PURPOSE: This paper reviews surgical modalities for treatment of keratoconu s at the threshold of the 20th century. METHODS: All ophthalmic literature from 1895 until 1925 in English and Germ an, available at the library of the Institute of Ophthalmology, London, Uni ted Kingdom, was studied with respect to this topic, RESULTS: Three thermal procedures were described; galvanocauterization with perforation, without perforation, and a non-contact application of heat to the corneal apex. Radial extension of a thermal burn to correct the minus cylinder represented a further modification. Excision of the conical area w as suggested either as a lamellar dissection or as a full thickness trephin ation. Incision of the cone appeared to be less popular. In staged procedur es, a combination of galvanocauterization, splitting of the cornea, conjunc tival flap, and a subsequent optical iridectomy were applied. CONCLUSION: The treatment of keratoconus 100 years ago used refractive surg ery to improve visual function by modifying corneal shape.