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Post Info TOPIC: Circular keratotomy
Fil


Veteran Member

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Posts: 31
Date: Fri May 27 9:30 PM, 2005
RE: Circular keratotomy
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Hi Hari,

A part of the technic of Doctor Jorg Krumeich consists to put an iron ring in your cornea. If you do this (Have you ever seen somebody with an iron ring in his cornea? It's strange and not nice to see..humm), you will increase the stretching which will weak the collagen fibrills and which is responsible for the developpement of the proteases inside your cornea!! As a consequence, your Kc will increase. In fact, this technic looks like Intacts, but in a worst case! It's dangerous to combine the placement of the ring with circular keratotomy. This last technic will decrease the stability of the cornea and creates a risk of perforation of the cornea.
A graft is stronger than a keratoconus cornea (Ok, this observation depends on the developpement of the disease...), it's a fact! As a result, it's less dangerous to do incisions in a graft, comparing to a keratoconus cornea (risk of perforation, not good stability). The problem of keratoconus is not only a biomechanical problem, but a biochemical problem too. Keratoconus depends on the unbalance between the production of collagen and the destruction of the fibrills by the proteases.

1)Where is the parasite? Perhaps there was a parasite at the beginning for some people who have keratoconus...But, we need to see the article of the discovery!!!

2) OK, it's possible to measure the bioelectrical signal generated by keratoconus.. Where is the model, the article? I'm sure that you can measure an electrical field in corneas after a lasik, etc...

3)Implosive effect?
OK for the center of the cornea, but keratoconus corneas have less collagen than "normal" corneas. Ok, the center is thicker than before, but around the center, you have less collagen. As a result, you can extend the conus..
I hope a good night for all.
Phil


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Executive

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Posts: 397
Date: Fri May 27 10:15 PM, 2005
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Hi Fil,


I totally agree with your comments concerning the implanting of the 'Ring'... I feel its invasive (that is, its creating a foreign body) and that the constant stress that would develop withen the eye would have long term negative effects.


We have spoken before about the effects of radial keratomy on a graft button vs. a Kc cornea, and I guess we will have to disagree on this. I personally would like to see long term clinical proof that incisions made upon KC corneas DO have a negative effect... its one thing to guess that this would be the case, quite another to actually know. These studies may exist, but show me papers of incisional surgery proformed on KC corneas and the long term results that 'scientifically'  state that this has a weakening effect.


Certain aspects of the PERK study results may go some way to showing this but these results were far from accurate (This has been supported by a number of diffrent experts in the field). As I've said before the cellular makeup of the graft button is far from stable, the mere fashion in which they are harvested shows scant regard for the biomechanical complexity of its host destination.


The part of Dr. Krumeich's work that I was referring to was of course the radial incisions and that he uses the strengtening effect of scar formation to stabilize his technique... this is the very basis of Mini Ark. And as you have pointed out one of its most argued...


Hari



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Date: Fri Jul 1 5:42 PM, 2005
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On further investigation it seems that I was wrong... I thought the ring inplant was expandable, similar to other intra ocular rings. But it seems that they are titanium and of fixed shape... with the purpose of adding support to the incisional operation.


But the use of circular rather than radial incisions still bothers me as this may adversely effect the nerve structure of the cornea... in much the way that the removal of corneal tissue during PK does.


Hari



-- Edited by Hari at 18:04, 2005-07-02

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Date: Tue Jul 12 10:31 PM, 2005
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Last wekk Dr.Krumeich operated me with the methode of the Circular keratotomy with a implanting of the 'Titan-Ring'. My Keratokonus stadium was 3. Up to this point there are no problems.Maybe that i cannot see more, but the KC can be stopped and a new contact-lense can be made easilier.


 



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Anonymous

Date: Wed Jul 13 2:32 PM, 2005
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Just wanted to say a warm welcome to you Andy...good to hear from you... its great to know that your doing well... I think your post has shed more light on this topic more than if you did not...so I thank you for that...

All the Best

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Executive

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Date: Wed Jul 13 6:26 PM, 2005
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Hi Andy,


Its great to hear from someone who has been operated by Dr. Krumeich... I have been following his work for some time now.


So, welcome to the forum... it really is so important that we hear from people such as yourself, people who have taken a brave step forward into these new and exciting techniques. I personally have had the mini ark operation at the Lombardi clinic in Rome (I think mini ark and your operation have much in common, although they are very diffrent procedures).


I would be interested in what Dr. Krumeich has to say about the healing process of the ciruclar incisions he makes, as you know many in the medical field prohibit operations onto a keratoconic cornea.


Actually it was Prof. Lombardi that first told me of Dr. Krumeich's work... Please keep us informed about your progress. I know that many are very interested in hearing what you have to say.


Regards and best wishes for your continued progress,


Hari Navarro



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Date: Mon Jan 16 10:27 PM, 2006
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3 weeks ago Dr.Krumeich took out the stitches. Everything seemed to alright, the konus didn`t become worser and the visus got a little bit better and i had no problems in the eye.


 


But after some days the ring began to the crown of the eye and felt the ring like a small pain. Now i have ti decide if i want to take the ring out or operate again and put it deeper..i really don`t know the answer. But im still sur of that its a good methd to "fight" against keratokonus.


 


If the cirkular Keratotmie does not stop the keratokonus you can do the x-linking.


 


Now i have a really hard time because of the pain in the eye and i dont know wgat to do.



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Executive

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Posts: 397
Date: Mon Jan 16 10:38 PM, 2006
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Hi Andy,
Sorry to hear that you are experiencing some problems following your operation... Maybe its just a case of your eye adjusting to the ring implant? I really dont know very much about this procedure but please keep posting your progress... and dont hesitate to ask for help.
What does your doctor suggest you do? Has this kind of thing happened to other of his patients? Like I said maybe its nothing to worry too much about... I know when I had Mini Ark that there was a period of time directly following the operation where the cornea is settling and your sight is adjusting... maybe you are experiencing something similar?
Like I said... keep us informed :)
All the best,
Hari

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