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TOPIC: bluesfan's x-linking


Senior Member

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Posts: 124
Date: Tue Oct 30 1:20 AM, 2007
RE: bluesfan's x-linking
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Hello everyone.

I am going to agree with you Yarsky.You have made your point.

Bluesfan has spoke.I am respecting his decision.He is a wonderful person and all i ever want is to help him choosing the best and experienced doctor there is to solve the keratoconus disease once and for all.I wont say further more because i gave my word and i can not break it.I am a man of believing to this values.

I will reffer you all to www.kcglogal.org to see for yourself as it is obvious this:

The UV-X corneal cross-linking system developed by Th. Seiler MD and E. Spoerl PhD.

Corneal cross-linking with a clinical history SINCE 1999 has been proven to be a reliable method for treating Keratoconus and Iatrogenic corneal ectasia.

It is an uncomplicated safe in-office procedure that can prevent the necessity for a corneal transplant.

Put these words in your heart and your kc eyes.Listen to this:Clinical experience since 1999.Now we have 2007 going for 2008.This is not something new as people wants to believe.And most important i havent heard of any kind of failure.The mother****er kc stops.Period.

Takecare,

P.S I will not post to this thread again.That is my decision.



-- Edited by Zeus at 02:25, 2007-10-30

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nothing else matters


Veteran Member

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Posts: 38
Date: Tue Oct 30 4:23 PM, 2007
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Dear Doctor,

Thank you very much for your explanations.

About the article about keratitis after C3R, it has just been added on medline :

1: J Cataract Refract Surg. 2007 Nov;33(11):1982-1984.Herpetic keratitis with iritis after corneal crosslinking with riboflavin and ultraviolet A for keratoconus.Kymionis GD, Portaliou DM, Bouzoukis DI, Suh LH, Pallikaris AI, Markomanolakis M, Yoo SH.
From the Department of Ophthalmology (Kymionis), and the Institute of Vision and Optics (Kymionis, Portaliou, Bouzoukis, Pallikaris, Markomanolakis), University of Crete, Crete, Greece; and the Bascom Palmer Eye Institute (Suh, Yoo), University of Miami Miller School of Medicine, Miami, Florida, USA.

A 21-year-old woman had crosslinking for keratoconus in the right eye; the left eye was scheduled for penetrating keratoplasty. Five days postoperatively, she presented with geographic epithelial keratitis and iritis. Analysis of tear samples by polymerase chain reaction confirmed the diagnosis. The patient was treated with oral steroids and acyclovir, with significant improvement. Two months postoperatively, the visual acuity was improved and there was no evidence of herpetic disease recurrence. Crosslinking can induce herpetic keratitis with iritis even in patients with no history of herpetic disease. Early diagnosis and proper treatment are essential for a favorable outcome.

What is your opinion about it ? What is the cause of this rare complication ?

Again, thank you very much.

Act

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Ophthalmologist

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Posts: 18
Date: Tue Oct 30 9:41 PM, 2007
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Dear Act:

It´s well known by ophthalmoligists that UV light, intense emotional stress and also fever can induce a recurrence of herpetic disease in the cornea. Before performing a C3R you may ask the patients for previous eye diseases. Sometimes herpetic conjunctivitis, which is the primary infection of the virus, occurs in the firsts years of age and neither the patient nor his/her relatives remember the episode. If you perform PRK, epi-LASIK or even LASIK, in which the excimer UV laser is utilized you can induce a recurrence of the disease. There is a paper in the same November issue of JCRS you posted from a Spanish group presenting a LASIK series of patients with history of herpes with no recurrence. In some cases they used prophylactic antiviral therapy.

I have done also several cases of LASIK in herpetic patients and i always give the patients oral famciclovir one week before and two weeks after the procedure.Just in case...

Regarding C3R the procedure itself doesn´t cause herpes. But the UV light can induce a recurrence in patients previously infected ( That could have happen many many years ago). So if you´re going to perform C3R, ALWAYS ask a patient about history of eye diseases in his/her childhood.

One the other hand, do you know that C3R coul be used for other eye diseases? We can treat fungal keratitis ( fungi are sensitive to UV) in case there´s no response to antifungal agents, immunological melting diseases such as rheumatoid arthritis with corneal melting, and recently corneal edema? New indications for C3r are unde evaluation, not only for keratoconus.

Hope i have given you some help about this topic.

Good night

-- Edited by Juanito at 22:45, 2007-10-30

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Juan


Executive

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Posts: 437
Date: Wed Oct 31 12:06 AM, 2007
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Hi!
I think this should go to the "X_linking thread", this is a general issue! Whatever. Just in case, x_linking patients are given antibiotic ointments or drops to take care of the cornea with abrased epithelium. What if that infection happend only because the epithelium was abrased and the antibiotic was not being applied properly by the patient herself?

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yarsky
jr


Veteran Member

Status: Offline
Posts: 33
Date: Wed Oct 31 8:15 AM, 2007
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Bluesfan,
how is your vision? is it getting better?

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Member

Status: Offline
Posts: 19
Date: Tue Nov 6 9:05 PM, 2007
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oops I'm very sorry I missed this post

The first thing I wish to say it's that discussion is good but everything should be say in a polite manner and if possible with good writing please.

Regarding the responses of the post I'm totally impressed that a doctor of the level of Juanito, after a long day work, still has the energy and goodness to enter an anonymous forum to explain things to us. Dr you have restored some of the faith in doctors I lost after a painful way during my ectasia development. I can't say which is the best crosslinking procedure since I'm not a doctor but even If I would disagree I would be impressed of you taking your time to come here and discuss.

Regarding Dr Alvarez de Toledo reputation for what I know it's awesome, this is obvious being the cornea consultant of the Barraquer institute, a well-known center for excellence. One patient that had a graft with Dr Alvarez de Toledo told me she had 20/20 uncorrected after and my local doctor recommends him to me, that's why he has always been my first option for a graft (hopefully I won't need)

Dr It will be a pleasure to visit you in the future, I would do it now but my situation is kind stuck. One eye 8-months after crosslinking, I think the wise thing to do is wait at least until 2 years (I still haven't found any opinion contrary to waiting after a ccl). The other may be slowly progressing maybe not  anyway just want to confirm progression before ccl, I think is better to not undergo the operation if you can since there is a risk of losing vision, but honestly I'm ready to do the operation again in Dresden at the first sign


BLUEFAN I can only say that I support you anyway I can, as a KC sufferer I know well the frustration of having only one thing to do:waiting. One thing I want to say is that even in the worst-case scenario (which may have a low probability) you could have a graft in that eye. Best luck and you can contact me by PM if I can serve you anyway.

best regards,

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