All of us Vs Keratoconus


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Post Info TOPIC: The essential Corneal graft?


Executive

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Date: Sat Jan 21 1:07 AM, 2006
The essential Corneal graft?
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When I hear of KC sufferers that have gone onto have Corneal graft for the most part I assume that their respective doctors have exhausted all other options. From what I have seen on the internet and read on the KC forums the assumption is that PK is offered only as a last ditch treatment.
But in this extract we see that purhaps this is not always the case:

“Our philosophy is, we let the patient tell us when they’re ready for surgery, within limits,”
Indianapolis surgeon Francis Price, M.D., said. “But when they’ve reached the point when they’re having difficulty functioning with the contacts, difficulty seeing, then we go ahead and do the surgery.”
That varies from one person to the next. “Some people are happy with 20/60 vision,” Dr. Price said.
“I usually try to encourage them to consider their difficulties driving. But when they have too much photophobia, too many problems with irritation or vision, then we do surgery.”
Some of these surgical cases may in fact be fairly mild cones, with no scarring and very little change on slit lamp examination, Dr. Price said.
Las Vegas surgeon Kurt Buzard likewise is inclined to offer surgery as a treatment option early in the
course of the disease. "We feel that if best corrected vision without a contact lens falls below 20/40, then we do a transplant," Dr. Buzard said. "We consider keratoconus to be a surgical disease, not a medical disease."
Dr. Price advocates surgery, particularly when using lamellar grafts, before the cones become too big.
“One of the things that we saw with epikeratophakia and now with the lamellar grafts, is that if you do the cones before they’re very big, you can do a deep lamellar graft, essentially down to Descemet’s membrane,” Dr. Price said, referring to the innermost layer of the cornea.
“Descemet’s has the endothelial cells on it, which really are the only cells you have to worry about for rejection.
Now, with newer techniques, we can do dissections right down to Descemet’s membrane, take off the diseased part of the cornea, and take a donor cornea and essentially wipe off the endothelial cells from that, which you just never want to do in a standard graft because that’s what keeps the cornea clear.”
Removing the endothelial cells eliminates most of the antigenic load of the donor cornea. This way, patients can taper off topical steroids quickly. There is little risk of graft rejection, and the eye is stronger in resisting injury. “One of the problems with a standard transplant is that if you take a hard blow to eye, even 20 years
after the surgery, it can rupture pretty easily,” Dr. Price said. “So this should give us a much stronger eye.”

The goal is to do the surgery before the cones get so big that a lamellar graft is no longer an option.
“The problem mechanically in doing these lamellar grafts is, if you have a big cone, and then you put the graft in and you push that cone down, you get wrinkling in the remaining tissue, Descemet’s, stroma,”
Dr. Price said. “And if you have much of that wrinkling, then a lamellar graft won’t work visually.
So, in keratoconus, we’re actually going to be better off doing these eyes sooner rather than later.”
In advanced cases involving a large and bulging cone, Dr. Price will do a standard full-thickness penetrating transplant to avoid wrinkling when the new cornea is placed on the eye.
Whichever approach a surgeon uses, ample evidence indicates that corneal graft surgery can permanently improve a person's quality of life. "These patients, if I do them at age 20 or 21, they will then go into their normal lives," Dr. Buzard said. "I see them once a year, and I have many patients that I’ve done at age 18 to 21, and they really don’t believe they have a disease anymore. And I think that’s the goal. If you solve the problem for them, then they feel like they’re normal."

Hmmmm... food for thought,
Hari



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Anonymous

Date: Sat Jan 21 3:54 AM, 2006
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I remember reading about a "eye care" centre who was saying that they like to do a transplant as soon as possible... the sooner the better was their view! but for who? them or the patient?... I wish i could find their web-site.


They was saying it was not worth waiting and a transplant was the best thing to do, even for teenagers! ...and thats what they have been doing with good results!



-- Edited by QuintriX at 03:56, 2006-01-21

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Member

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Posts: 18
Date: Mon May 10 8:51 AM, 2010
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Hi my recommendation as a patient who has re-grafted both eyes and has had good vision in the first 5-10 years after surgery is that " Stay with contact lenses as long as they give you satisfactory vision and can be tolerated and Do Not opt for corneal transplant unless there is no other way".

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