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Post Info TOPIC: Urrez-Sawalij syndrome


Executive

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Date: Sat Jun 4 10:28 AM, 2005
Urrez-Sawalij syndrome
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I came across this somewhat dated article regarding complications related to corneal graft:  The "Urrez-Sawalij" syndrome confirms our assumptions that in the basis of the disease (Keratoconus)  lie not only cellular dislocations in the cornea that lead to its thinning from the center to the periphery, but also changes in the anterior chamber angle that prevent the chamber fluid outflow from the eye and lead to the straining of the cornea, and after keratoplasty create conditions for the tension in the eye and appearance of its sequelae.


Full text: http://www.dog.org/1998/e-abstract98/498.html


I was wondering if any other members had heard of this?


Hari



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Anonymous

Date: Tue Jun 7 8:35 AM, 2005
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I have not heard of this before...and I am really really feeling bad for people in the kc medical loop.


...I can well imagine law-suits that could be issued due to people not told about the possible risks with these traditional treatments (Transplants & Contact Lenses)...


And of course with out knowing about things like what you have highlighted Hari....then it would be forever "under the carpet" and always a problem...without solutions sort after, as a lot of people think everything is ok...well there is and are problems that need to be addressed.


...not to imagine finding out about all this when it is too late to do anything about it... 



-- Edited by QuintriX at 10:12, 2006-03-06

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Executive

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Date: Fri Dec 9 11:18 AM, 2005
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Very interesting article!



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yarsky


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Date: Fri Dec 9 5:34 PM, 2005
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I almost forgotten that I'd posted that... its been a long time!!! I have to say that I havnt seen this syndrome mentioned anywhere else in regards KC.
Anybody else out there heard of it?

Hari

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Ophthalmologist

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Date: Sun Mar 5 9:41 PM, 2006
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Hi everybody:


I am a corneal surgeon located in Barcelone, Spain. I perform more than 150 corneal grafts per year. Among them maybe i do 30-40 cases of keratoconus patients every year. I visit hundreds of kc patients and last month i diagnosed my 15 years old son having incipient kc. I entered this forum last week and found very nice posts and good feelings between everybody. I totally agree with all the comments searching less invasive procedures than penetrating keratoplasty (PK), but donīt forget that depending on the stage of the disease, PK is the only solution to restore sight. And donīt forget that PK has a succes rate of 96% at ten years. We can discuss about lamellar surgery, but itīs too early to compare its results with PK.


I would like to clarify some aspects of complications of PK. Urrets-Zavalia (this is the correct name of the authors who first described this complication ) syndrome is a pupillary block as a result of not performing peripheral iridotomy ( small hole in the iris) during the surgery of penetating keratoplasty. You can find this complication not only after PK; cataract surgery and almost every surgical procedure you perform entering the anterior chamber of the eye can induce it. The increase of ocular pressure causes a collapse of some abnormal blood vessels that are present in some (very few) patients inducing the atrophy of all the iris. Maybe during the last 20 years of professional exercise iīve seen three or four cases among thousands of PK, so its incidence is extremely rare.


I write this post trying to clarify this question that some times can be misunderstood and give you some clear information about it.


 



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Juan


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Date: Sun Mar 5 11:07 PM, 2006
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Hi Juanito,
And thank you very much for contributing to our forum. Thank you also for giving us an insight into the Urrets-Zavalia syndrome (It seems it is a minor point of focus in the Keratoconus story).
There has been much discussion on this and other boards regarding the 96% success rate of which you speak.
I personally feel that it is a misleading statistic that lends graft recipiants to assume that they have very little to worry about following PK.
The question is 'What defines success?'. After the 10 year mark if the graft has not rejected, is this success?, what of the quality of vision? And what of the fact that contact lenses are almost always required following PK? What effect does this have on the donor cornea?
The question should be 'Are 96% of graft patients happy after the 10 year mark?'.
You are quite right in saying that in advanced cases PK is the only viable solution. But we are seeing more and more the emergence of techniques such as Mini ARK and Cross-linking to treat advancing Keratoconus.
The question is when to employ them? There is no way of knowing how far a particular patients KC will progress.
But if the ultimate solution is to graft then I think that these procedures and those like them need to be given renewed attention from the medical world as a whole. Its not good enough that we just let nature take its course.
My best wishes to your son, it seems that the age range for KC is progressively getting younger?? I hope that he and you can continue to add your expertise to the forum,
I look forward to your posts,
Regards,
Hari Navarro

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Anonymous

Date: Sun Mar 5 11:17 PM, 2006
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Hi Juanito good to have your experiance and knowledge here. Sorry to hear that your son has KC... but i did not understand when you said "incipient kc" ?


Anyway I think everyone is ageed that corneal transplants should be avoided if possible and that its worth a good try to reduce the number of corneal transplant's which are taking place... if the success of a transplants is so very good... then what is the problem in kc? ...because there is a problem thats why there are so many alternative treatments being developed for patients.


The success of the transplant measured from a patients prespective is what is important and that is different to what a surgeon calls a success... as for one example, when some is intolarant to contact lenses they are told to have a corneal transplant... and this is when 60% of people still need to wear contact lenses after-wards!! So what should they do?


These question are not aimed at you Juanito, its just that transplants are not the answer and we would like to keep our own corneas... 


What's in the "pipe-line" is to do crosslinking at diagnoses to avoid all these problems, including the problems with Hard Contacts Lenses particularly on a weaknened cornea (scarring, warpage ect)


Have you got a web-site Juanito, what hospital do you work at? 


All the best



-- Edited by QuintriX at 21:43, 2006-03-08

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Ophthalmologist

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Date: Tue Mar 21 9:46 PM, 2006
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Hi everybody again:


Of course the main goal of medicine is avoiding surgery.... But with surgery we try to solve the situations that are not possible to be treated by other means. I work in a very solid reputation ohthalmology clinic in Spain, Barcelone, known as Barraquer Eye Center.It is a reference clinic for all Spain, so most of the patients which arrive to our hands are patients with stages III or IV of the disease, with CL intolerance and treated previously by another phisicians around our area, so the only solution we can offer to them is corneal grafting. We do more than 350 corneal grafts per year, 20% for KC. We started doing corneal grafting in the 60's so we have a huge volume of post op patients. As I posted, prognosis is very good and we have patients followed more than 40 years... BUT


-Dod you know that KC can start again in the patient's remaining cornea 15 to 25 years after corneal transplantation causing a progressive astigmatism? See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12792474&query_hl=1&itool=pubmed_docsum


-What will happen with intracorneal rings after 20 years?


-How often cross linking should be repeated?


So we donīt have answers yet to so many questions. The most important thing in my opinion is to do research in preventing progression of keratoconus once diagnosed. We have to do prospective studies on the influence of eye rubbing, which for us is the major enviromental cause of KC in genetically predisposed patients, routinely perform corneal topography in children with astigmatism, analyze the influence or treating allergic diseases in these patients, etc.


I agree totally with you that non-invasive treatments such as intracorneal rings, already performed at my Institution, and cross-linking, which we are going to start soon, are very good methods in selected cases, and maybe in the very next future we will use routinely in kc starting cases.But as everything in medicine, we need results, statistically proven methods, to treat our patients.Thatīs why we canīt go faster.


And donīt forget that corneal transplant surgery is evolving rapidly. We are doing deep lamellar grafts in which the endothelium is not grafted, so the incidence of rejection is very very low, and post-op astigmatism as well. In case thereīs not other method to restore the vision, corneal grafting is yet a measure in our surgical armamentarium with good results.


And congratulations to everybody for the Forum. Iīm at San Francisco right now in the most important meeting about cataract and corneal surgery and i can tell you that more than 100 presentations, papers, videos and symposia were about keratoconus. So weīre working hard to help you!



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Juan
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