Trehalose In Stabilization Of Disease Progression In Keratoconus Via Autophagy Modulation

To describe the utility of trehalose, a cellular autophagy activator with protective effect on stress-induced inflammatory response in human cornea, in the management of keratoconus (KC).

Tertiary Eye Care Hospital

The study included 7 patients (13 eyes) with mild to moderate KCs. The patients underwent detailed clinical examination and imaging including corneal topography, biomechanical assessment, epithelial mapping, and polarization sensitive optical coherence tomography (PS-OCT). Based on the severity and the risk of progression of the keratoconus disease, those with low risk of progression of keratoconus were started on topical trehalose 3% containing artificial tear supplements in the frequency of 4 times per day.  During the treatment, serial corneal topography and phase retardation (PR) maps of PS-OCT were assessed to look for halt in progression of the disease.

The patients were treated for a median duration of 8 months (range 5-23 months) with topical trehalose 3%. The pre-therapy maximum keratometry (Kmax) was 50.1D (range 46.2D-61D), mean keratometry (Kmean) was 46.2 (range 41.2D-48.5D), and median TCT was 470µ (455µ – 512µ). The median post therapy Kmax was 48.6 D (range 45.2D-60.2D), median Kmean was 45.5D (42D-47.9D), and median TCT was 465µ (range 440µ -512µ).The serial PR maps of eyes treated with topical trehalose showed improvement in collagen fibril orientation compared to baseline status.

Medical management with topical trehalose 3%, helps in stabilizing the keratoconus disease in patients with low risk of progression. Trehalose modulates autophagy, and controls inflammation in ocular tissues. The collagen imaging using PSOCT in patients with keratoconus treated with topical 3% trehalose shows better collagen fibril orientation demonstrating its positive impact on the extracellular matrix metabolism in these patients.