keratoplasty

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
F

fabiolablake

Incompetent
7+ Year Member
15+ Year Member
20+ Year Member
Joined
Jul 15, 2003
Messages
165
Reaction score
0
For the past decade and a half I have been suffering from keratoconus-like symptoms and have tried multiple treatments. They have had me wearing toric lenses for the past few years, but are beginning to fail. Before this, they had my wearing gas permeable hard lenses that were not working well for me. At this point, I'm looking for a solution to this problem and have been considering a corneal transplant. For those of you who are interested in ophthamology or in an ophthamology residency give me the pros and cons of a corneal transplantation, risks vs. benefits, potential cost, and recovery time please? I want to become a surgeon and I'm hoping that a procedure such as this will not compromise that hope. I appreciate your help.

Blake
Members don't see this ad.
 
If your vision remains bad with contact lenses, then you likely need to consider a penetrating keratoplasty procedure (PKP),

Following the PKP, there is a long process of rehabilitation and care. You need frequent follow-ups with the cornea specialist, and there may be high astigmatic error until stitches are removed gradually. You'll need to use steroid drops to fight rejection and failure. Also, any sign of infection in the graft is a medical emergency.

The risks of a PKP: pain, discomfort, decreased vision, infection, severe hemorrhage due to hypotony during the procedure with possible subsequent loss of the eye and vision, graft failure, and needing repeat PKP. If things are done under general anesthesia, then there are the small risks of stroke and death.
 
fabiolablake said:
"... For those of you who are interested in ophthamology or in an ophthamology residency give me the pros and cons of a corneal transplantation, risks vs. benefits, potential cost, and recovery time please? I want to become a surgeon and I'm hoping that a procedure such as this will not compromise that hope. I appreciate your help.

Blake
Click to expand...

Dear Blake,

1. Rehabilitation may entail up to a year's worth of follow up.
2. Although recent microsurgical techniques have increased the uncorrected vision post PKP to 20/25 in at least 90% of the cases, there is still a probability that you might still need either spectacle either and or contact lens correction post-surgical. With 20+ years rehabilitating post PKP cornease with contact lenses, this is still an uncertain science.
3. Graft failure can occur at any time, sometimes many years later.
4. Grafts require good beds. Such things as limbal stem cell problems, occult Herpes Simplex, etc, can surprise a surgeon or complicate the post-op period.

Regards,
Richard_Hom
 
Members don't see this ad :)
Sorry to bring back such an old thread but I'm wondering if there are any advancements, procedures or updates to the OP's questions in the past 12 years. I have keratoconus and use the rigid gas permeable lense but it's quite irritating and sometimes painful. Starting med school so I probably wouldn't want to do anything till after school. I meant to bump for everyone obviously as its been a while and I doubt the person I quoted will see this lol


Sent from my iPhone using SDN mobile app
 
FutureDO08 said:
Sorry to bring back such an old thread but I'm wondering if there are any advancements, procedures or updates to the OP's questions in the past 12 years. I have keratoconus and use the rigid gas permeable lense but it's quite irritating and sometimes painful. Starting med school so I probably wouldn't want to do anything till after school. I meant to bump for everyone obviously as its been a while and I doubt the person I quoted will see this lol


Sent from my iPhone using SDN mobile app
Click to expand...

Www.pubmed.net

Www.aao.org

Eyewiki

Look up collagen cross linking. The answer is pretty much, no not much advancement in the United States.

Sent from my iPhone using SDN mobile app
 
  • Like
Reactions: 1 user
DrZeke said:
Www.pubmed.net

Www.aao.org

Eyewiki

Look up collagen cross linking. The answer is pretty much, no not much advancement in the United States.

Sent from my iPhone using SDN mobile app
Click to expand...
Thanks, I almost wish it had been bad enough to have tried the procedure a couple years back. I just don't want it to kick into overdrive and get bad while I'm in school lol. We'll cross that bridge when we get there I guess


Sent from my iPhone using SDN mobile app
 
  • Like
Reactions: 1 user
To the OP. Yes there absolutely are other options besides a PKP. I would look into some of the clinical trials that are being put on by Avedro (KXL). This is a procedure I had done to my R eye. Four years later, I have not seen any decrease in visual acuity, corneal pachymetry (thickness), or any significant change in corneal K values (steepness of the cornea). I was able to go from an RGP back into a soft toric lens and currently my VA is 20/25 +2. I would absolutely consider getting your corneas crosslinked before you decide to undergo a PKP. The procedure costs around $2000 an eye for CXL. There are multiple centers in Europe that are now performing CXL and then topography guided PRK (like LASIK without a flap creation). The software has recently been approved in the US but results are still forthcoming on patients with Keratoconus who undergo CXL and subsequent Topo-PRK. This may be an option for you in the future as technology advances.
You may also consider trying out a scleral lens. This is a large diameter RGP that rests on the sclera (white part of the eye) instead of on the cornea (like the RGP). They are considered comfortable, protective to the cornea, and provide excellent vision. They are similar in maintenance to an RGP. Find a good optometrist to fit them for you who specializes in Scleral lenses. I would not, I repeat, I would not get a PKP until you have exhausted all of these options. I have seen many many people with failed grafts and repeated grafts. You can always get a PKP later on down the road if these options fail.
 
i2020 said:
To the OP. Yes there absolutely are other options besides a PKP. I would look into some of the clinical trials that are being put on by Avedro (KXL). This is a procedure I had done to my R eye. Four years later, I have not seen any decrease in visual acuity, corneal pachymetry (thickness), or any significant change in corneal K values (steepness of the cornea). I was able to go from an RGP back into a soft toric lens and currently my VA is 20/25 +2. I would absolutely consider getting your corneas crosslinked before you decide to undergo a PKP. The procedure costs around $2000 an eye for CXL. There are multiple centers in Europe that are now performing CXL and then topography guided PRK (like LASIK without a flap creation). The software has recently been approved in the US but results are still forthcoming on patients with Keratoconus who undergo CXL and subsequent Topo-PRK. This may be an option for you in the future as technology advances.
You may also consider trying out a scleral lens. This is a large diameter RGP that rests on the sclera (white part of the eye) instead of on the cornea (like the RGP). They are considered comfortable, protective to the cornea, and provide excellent vision. They are similar in maintenance to an RGP. Find a good optometrist to fit them for you who specializes in Scleral lenses. I would not, I repeat, I would not get a PKP until you have exhausted all of these options. I have seen many many people with failed grafts and repeated grafts. You can always get a PKP later on down the road if these options fail.
Click to expand...


Thank you very much. Someone suggested I looked into PROSE so I definitely will! Glad to hear you had success with cxl. What was your recovery time like?


Sent from my iPhone using SDN mobile app
 
I had the procedure done approximately 3 months before starting medical school. The first day is very painful if you choose to get the epi-off procedure (there are two versions currently: epithelium on and epithelium off). Epi-off includes a debridement of the superficial layer of the cornea to allow the Riboflavin solution (Vibe-X) to penetrate the corneal stroma. After a couple of days, the pain wears off, but the cornea is incredibly hazy and slightly edematous. After about two weeks I could tell things were getting clear again and I began to not think about it. I wore my pre operative glasses rx during this time. After a month, my surgeon deemed my cornea allowable for a new contact lens fit (soft only), and so I opted to try it. Now 4 years later, I am very happy that I chose to get it done. The side effect profile is really quite small in comparison to a PKP or other ophthalmic procedure. Data has been around on this procedure since the early Dresden Germany trials more than 10 years ago. Honestly, you could most likely return to work in about 2-3 days as long as you could go in for frequent follow-up visits (1 day, 1 week, 1 month, 3 month). PM me if you need more help.
As a side note, the PROSE is just simply a scleral lens. You may want to try several different manufacturers with your optometrist if you deem to go this route.
 
Did you have cross-linking done in the United States?
 
i2020 said:
I had the procedure done approximately 3 months before starting medical school. The first day is very painful if you choose to get the epi-off procedure (there are two versions currently: epithelium on and epithelium off). Epi-off includes a debridement of the superficial layer of the cornea to allow the Riboflavin solution (Vibe-X) to penetrate the corneal stroma. After a couple of days, the pain wears off, but the cornea is incredibly hazy and slightly edematous. After about two weeks I could tell things were getting clear again and I began to not think about it. I wore my pre operative glasses rx during this time. After a month, my surgeon deemed my cornea allowable for a new contact lens fit (soft only), and so I opted to try it. Now 4 years later, I am very happy that I chose to get it done. The side effect profile is really quite small in comparison to a PKP or other ophthalmic procedure. Data has been around on this procedure since the early Dresden Germany trials more than 10 years ago. Honestly, you could most likely return to work in about 2-3 days as long as you could go in for frequent follow-up visits (1 day, 1 week, 1 month, 3 month). PM me if you need more help.
As a side note, the PROSE is just simply a scleral lens. You may want to try several different manufacturers with your optometrist if you deem to go this route.
Click to expand...
I've got 4-5 months before school starts. I may begin working even more OT to look into going to the UK. Would you be able to PM me info as to who you used and pricing etc?


Sent from my iPhone using SDN mobile app
 
DrZeke said:
Did you have cross-linking done in the United States?
Click to expand...
Yes I did. It was under an FDA clinical trial. I paid approximately 2500USD. It was under the old CXL protocol which required corneal debridement and 30 minutes of continuous treatment time under the UV light source. VIbeX was instilled every 2 minutes during the treatment. For one week I wore a BCL. Epi defect went away around 7 days. Some corneal haze (2+) existed for approximately a month. I was given a few percocets for the pain and placed on Predforte and Vigamox. Lots of artificial tears to keep surface moist.
KXL almost received FDA approval a year ago in April but was sadly denied due to lack of long term data in the US. Avedro is running ACOS 005 clinical trial in the US but it is not currently enrolling participants. (https://clinicaltrials.gov/ct2/show/NCT01972854?term=KXL-005&rank=1) You can look for other trials on the site that might be enrolling but I believe Avedro is the only company in the US doing this right now. There are some clinical sites that will offer this as a service "off-label".
 
  • Like
Reactions: 1 users
Thank you so much @frezz219 . I just came home with the scleral lense and I can see once again without all of the pain I had for 2 years! It brought some tears to my eyes no pun intended lol. @i2020 I thank you too. My new optometrist happened to know of someone in Greece for cross linking and knows of someone in my area doing it under FDA protocol. I'll be looking into this too. I appreciate you guys so much


Sent from my iPhone using SDN mobile app
 
You must log in or register to reply here.
Next unread thread
Top