All of us Vs Keratoconus

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Post Info TOPIC: The Epithelium is very clever!

Phase Two

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Posts: 482
Date: Sun Oct 29 10:35 AM, 2006
The Epithelium is very clever!

Now this is pretty important, as not a lot of people know about it, it also can not be found on the internet, it was put across to a few choice eye-care professionals interested in kc, at a meeting I went to, from the specialist work that was carried out on this topic for a great number of years.

The Epithelium is very clever...why?

If in the advent of an assault happening to the cornea through an abrasion, "dent", refractive surgery complications, etc... The Epithelium compensates its self, by getting thinner or thicker to keep the outer-surface the same, in the round shape as it always has been. (this only works to a point)

The other thing I saw the Epithelium can do which is clever, (on a picture on an over head slide) was the ability to "ride over" a "dent" on the cornea, like a "bridge" or a highway "fly-over", in that just "flying over" the problem area, to keep the cornea round, when possible.

So what does this mean to us?

It means that "dents" to the cornea caused by hard contact lenses by various degree's in abrasions/friction/rubbing which in turn causes vision to decrease HAPPENS with out the Dr/fitter knowing why?... the fitter/Dr may "think" the abrasion has healed and all is well and back to normal (but the Epithelium is masking the "dent") and so they end up wrongly blaming it on your Keratoconus if your vision has got worse, when in reality they are ignorant to the fact's about the Epithelium being very clever... as already mentioned, and they have not got the equipment needed to look for this.

Vision may be still be readable at the same point on an eye chart, but with contrast and clarity going down, with wave-front analysis for example of a transplanted cornea and what can be seen from it, it was seen to be very poor due to the light not passing throught it on a straight path, there was abrasions, lots of them in the way... so when someone says they can read so much of a eye chart, in reality the vision they have is a poor quality one in what they can see.

When Corneal Topograpgy is used to "diagnose" KC, it is only an indicator that KC is present and so strictly speaking it can not diagnose Keratoconus. This is because the Epithelium "masks" the development of the cone pushing to come out on to the surface. This is very very important in laser surgery, but alas this thinking is not known... hence "Keratoconus post laser" is the result!! (kera-elastia)

In summary-The Epithelium is very clever, no one knows how it knows when to ride over/mask problems when needed to, in return it gives us a true diagnoses making any laser surgery full proof.

-- Edited by QuintriX at 21:18, 2006-10-29



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Posts: 437
Date: Sun Oct 29 9:03 PM, 2006

Hi Quitrix!
very intersting insight! I remember that the epīthelium is several layers of cells, special epithelial cells. They grow and are renoveled from the limbus, an intemeidary part between cornea and sclear. The precise dynamics of the epithelium cells, for example, when there is an abbrasion - is a subjcet, IMHO, of physical modeling. I see it as " a colony of cells". This colony lives, functions according to special rules. So when there is a perturbation to the colony, the colony responds: it rearanges, cells start to function differently,...And in particular, which is also an intrigue, there is a signal that epithelium sends to the keratocytes. In a way keratocytes, feel that there is something wrong with the epithelium AND they in their own turn start to function differently, aiming to minimize the impact of that something. So, a CL (RGP or S) IS a genuine, strong perturbation to cornea in general and first of all to epithelium.

-- Edited by Yarsky at 21:03, 2006-10-29



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Posts: 397
Date: Mon Oct 30 12:50 PM, 2006

I remember one of the very first things that Prof. Lombardi told me when I first visited his clinic... He said that every day he thanks god for the Epithelium :)
He went on to discuss many of the things you saw in the slide presentation Quintrix and how knowing these functions aided him in understanding fully the consiquences of his surgery.
Well done mate you have highlighted yet another important part of the jigsaw :)


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