Well if there is no doner tissue and there are places where there is that, then its worth a go... try telling them its for the bin. But Dr jay will do a dalk for them
Twisting the KC way!
Moderators: Anne Klepacz, John Smith, Sweet
What a waste of time posting to you Jay! this method is a method just like every other method with its advantages and disadvantages, no one said it was a "cure all" or better than something else or even it would help everyone, so don't try to act as if your the authority on KC sugery and your getting a bit silly now!
Well if there is no doner tissue and there are places where there is that, then its worth a go... try telling them its for the bin. But Dr jay will do a dalk for them
Well if there is no doner tissue and there are places where there is that, then its worth a go... try telling them its for the bin. But Dr jay will do a dalk for them
-
jayuk
- Ambassador
- Posts: 2148
- Joined: Sun 21 Mar 2004 1:50 pm
- Location: London / Manchester / Cheshire
Sajeev
I dont know what your problem is towards me and ive tried to ignore your uneducated comments but a few things that I must stress here
a) Noone posts to anyone!..this is an open forum..and each and everyone has a right to say what they want in reason..this is not your site where you can edit your posts and others and remove threads and distort messages....I can attempt to make you look like a 2 year old from an old thread on your board...which you had to take down in shame as I ripped you apart on your views before!......in fact the amount of times Ive had to own you is very embarrasing!
b) everyone has there own right to express there opinions...and thats what I, along with others did....as long as its there view and their perspective and its within reason
c) I can assure you that noone is an authority on KC related unless you are qualified..so that definately rules me out of the book!and judging from old posts of yours where you calls Grafts Graphs, rules you out as well!... so your comment there just shows a little insecurity on your part
d) I can say what I like.....based on the info I have...and my personal thoughts are that this treatment is useless...in KC...as you are basically going through the emotions and procedures of a transplant only to have to more than likely; go through it again once the KC has progressed......not even mentioning the recovery etc that you have go through with this method and then also another graft!
And as far as this procedure being done in other countries.....well you have shown your lack of intelligence and understanding here...and ill educate you a little as to why!..as thats all I seem to do with you!
I can assure you that if they can transplant the cornea than they can get the tissue..more so in the remote place.....the underlying problems we have in places like Africa et al; FOR EXAMPLE, is the skill shortage which they have to
i) transplant
ii) basic drugs
iii) overall opthalmic knowledge and treatment....and thus this is why grafts are not performed, and why people suffer from KC and cant get any treatments...EVEN basic Lenses.......
As far as any other locations where donor tissue isnt available, it is bought in! and if its an emergency I assure you this is whats done!
So before you try and comment, try and get facts and address underlying causes and issues on why treatments arent even available...rather than blanket covering reasons to try and justify such ridiculous treatments
Its all very well sitting there having mild KC and not even begining to understand the effects of having Advanced KC is to a person....but when you try and put forward such treatments to others whom come here for knwledge and information...THIS can be dangerous!
Now the best thing to do on here..is that you ignore my posts..and l just laugh and ignore yours!!
I dont know what your problem is towards me and ive tried to ignore your uneducated comments but a few things that I must stress here
a) Noone posts to anyone!..this is an open forum..and each and everyone has a right to say what they want in reason..this is not your site where you can edit your posts and others and remove threads and distort messages....I can attempt to make you look like a 2 year old from an old thread on your board...which you had to take down in shame as I ripped you apart on your views before!......in fact the amount of times Ive had to own you is very embarrasing!
b) everyone has there own right to express there opinions...and thats what I, along with others did....as long as its there view and their perspective and its within reason
c) I can assure you that noone is an authority on KC related unless you are qualified..so that definately rules me out of the book!and judging from old posts of yours where you calls Grafts Graphs, rules you out as well!... so your comment there just shows a little insecurity on your part
d) I can say what I like.....based on the info I have...and my personal thoughts are that this treatment is useless...in KC...as you are basically going through the emotions and procedures of a transplant only to have to more than likely; go through it again once the KC has progressed......not even mentioning the recovery etc that you have go through with this method and then also another graft!
And as far as this procedure being done in other countries.....well you have shown your lack of intelligence and understanding here...and ill educate you a little as to why!..as thats all I seem to do with you!
I can assure you that if they can transplant the cornea than they can get the tissue..more so in the remote place.....the underlying problems we have in places like Africa et al; FOR EXAMPLE, is the skill shortage which they have to
i) transplant
ii) basic drugs
iii) overall opthalmic knowledge and treatment....and thus this is why grafts are not performed, and why people suffer from KC and cant get any treatments...EVEN basic Lenses.......
As far as any other locations where donor tissue isnt available, it is bought in! and if its an emergency I assure you this is whats done!
So before you try and comment, try and get facts and address underlying causes and issues on why treatments arent even available...rather than blanket covering reasons to try and justify such ridiculous treatments
Its all very well sitting there having mild KC and not even begining to understand the effects of having Advanced KC is to a person....but when you try and put forward such treatments to others whom come here for knwledge and information...THIS can be dangerous!
Now the best thing to do on here..is that you ignore my posts..and l just laugh and ignore yours!!
KC is about facing the challenges it creates rather than accepting the problems it generates -
(C) Copyright 2005 KP
(C) Copyright 2005 KP
I've been out visting family and enjoying this lovely weather!!... looks like you got nothing better to do!!! -
GarethB
- Ambassador
- Posts: 4916
- Joined: Sat 21 Aug 2004 3:31 pm
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and contact lenses
- Location: Warwickshire
Can we please stick to the subject in hand rather than having a go at each other please?
We all know why the forum is here so there is no need to reiterate it here.
This is different techneque brought to our attention which like any other we discuss in some detail.
From this we form our own conclusions.
We all know why the forum is here so there is no need to reiterate it here.
This is different techneque brought to our attention which like any other we discuss in some detail.
From this we form our own conclusions.
Gareth
-
rosemary johnson
- Champion
- Posts: 1478
- Joined: Tue 19 Oct 2004 8:42 pm
- Keratoconus: Yes, I have KC
- Vision: Contact lenses
- Location: East London, UK
If I've understood this aright, they do a graft operation which takes out a fairly large section of your cornea, and then sew it back in the same hole, but an different way round, so that the bit that was over the pupil is now out to one side, and the bit that's now over the pupil was previously over sclera (white bit) or possibly iris, and not being looked-through.
Hmmm.
I can see this might be used for:
1. people who have only very early stages KC which only affects the very centre of their cornea, and that the outer regions are so far relatively unaffected.
2. people with heavy scarring over the centre, eg from having several hydrops.
In both cases the person, and the treated eye as a whole, still have KC.
In case 1, the KC might still progress, and affect the piece now over the pupil - and presumably, the piece formerly over the pupil will also progress. So the operation may have bought you time, but if/when the condition progresses, you'll still have KC, and you may well have a very odd shaped eye onto which to try to fit the contact lenses that are now inevitable (I presome it is not possible to keep doing one of these operations every few years due to wear and tear on the cornea from repeated grafting).
In fact, the increased irregularity of shape of the eye from the healing process of a graft, even a self-graft, plus having the thin, soft KC_affect area to one side, probably means you'd need correction anyway after the operation, and the odd shape would likely make it harder to fit a contact lens to it than to fit one to an eye with early-stages KC that is only affecting a small area that can be rotarted out of the way.
In case 2, you'd be removed the scarred area from ou tof the direct line of vision, but the bit of cornea put in front of the cornea would still have KC and gives the problems of having a KC-affected bit of cornea in front of the pupil. In fact, to have had several hydrops and as a consequence got enough bad scarring to be contemplating surgery, you've probably got fairly advanced KC already, and the bit put in front of the pupil would be markedly thinned with the KC even if not yet scarred.
i have no idea how much more likely hydrops would be to recur in rotated bits of cornea thus inserted - or indeed how likely one might be to get hydrops off-centre. Given the theory that the post-hydrops scarring actually strengthens the cornea, and thus makes a second hydrops in one eye unlikely, and the fact that the new section putin front og the pupil has no such strengthening, I'd have thought that placing a fresh piece of cornea with advanced KC into a central position would only increase the risk of a central-area hydrops - particularly in someone who has alrady had problems with hudrops, leading to them considering surgery.
of course, someone with KC that advanced would be wearing lenses anyway, and the same considerations about how to fit lenses ontot he resulting eye shape all apply again, in spades.
AIUI, someone who has had hydrops and resulting scarring wouldn't be in line for a DALK (partial-thickness transplant) anyway, so anything that would rule that out in future is not a consideration.
As far as the people in case 1 are concerned - those with only mild KC, since it has not advanced beyond the very central region - one has to ask why one would go for surgery with its attendant risks when the condition is only mild and no-one knows how much it may ever progress anyway? There are more risks to surgery than rejection of a donor cornea - adverse reactions to anaesthetics, for one; infection in the incision, even foreign bodies falling in (!!!!) or triggering the growth of a cataract. For example. There are many people who wear contacts lenses all the time for "ordinary" short sightedness, and someone with mild KC isn't so far from those. Who'd go for surgery and its risks rather than wear contacts, when they are still at a stage they can wear fairly ordinary ones? - or even specs?
The people I can see this might be very useful for would be as a "last resort" for those people reckoned to be too allergic to risk transplanting because they'd almost certainly reject any donor tissue. This might at least buy them some time - though with the problems of fitting contacts over the result to enable decent vision, whether a medical "success" would equate with a happy patient is another matter.
Trouble iwth that is, how do you know someone is in this category before they've had a transplant and it has rejected and rejected and..... by which time they won't have their own tissue left to use. Maybe the second eye of someone who had rejection problems in the first eye??
Absence of donor tissue?? - well, maybe, but given the development of tissue donor banks, if there is really absolutely no donor tissue available in a certain area, I'd wonder whther the expertise, and the post-op medication, would be available and up to scratch either....
ANother possibility: I wonder if this technique might come into its own in future in combination with some of the stem cell techniques currently under research? - though even if these would reduce the issue to one of replacing a "flatter" piece for a "steeper" piece of now "cured" cornea, the problem of fitting a lens onto the resulting odd shape may still persist.
Rosemary
Hmmm.
I can see this might be used for:
1. people who have only very early stages KC which only affects the very centre of their cornea, and that the outer regions are so far relatively unaffected.
2. people with heavy scarring over the centre, eg from having several hydrops.
In both cases the person, and the treated eye as a whole, still have KC.
In case 1, the KC might still progress, and affect the piece now over the pupil - and presumably, the piece formerly over the pupil will also progress. So the operation may have bought you time, but if/when the condition progresses, you'll still have KC, and you may well have a very odd shaped eye onto which to try to fit the contact lenses that are now inevitable (I presome it is not possible to keep doing one of these operations every few years due to wear and tear on the cornea from repeated grafting).
In fact, the increased irregularity of shape of the eye from the healing process of a graft, even a self-graft, plus having the thin, soft KC_affect area to one side, probably means you'd need correction anyway after the operation, and the odd shape would likely make it harder to fit a contact lens to it than to fit one to an eye with early-stages KC that is only affecting a small area that can be rotarted out of the way.
In case 2, you'd be removed the scarred area from ou tof the direct line of vision, but the bit of cornea put in front of the cornea would still have KC and gives the problems of having a KC-affected bit of cornea in front of the pupil. In fact, to have had several hydrops and as a consequence got enough bad scarring to be contemplating surgery, you've probably got fairly advanced KC already, and the bit put in front of the pupil would be markedly thinned with the KC even if not yet scarred.
i have no idea how much more likely hydrops would be to recur in rotated bits of cornea thus inserted - or indeed how likely one might be to get hydrops off-centre. Given the theory that the post-hydrops scarring actually strengthens the cornea, and thus makes a second hydrops in one eye unlikely, and the fact that the new section putin front og the pupil has no such strengthening, I'd have thought that placing a fresh piece of cornea with advanced KC into a central position would only increase the risk of a central-area hydrops - particularly in someone who has alrady had problems with hudrops, leading to them considering surgery.
of course, someone with KC that advanced would be wearing lenses anyway, and the same considerations about how to fit lenses ontot he resulting eye shape all apply again, in spades.
AIUI, someone who has had hydrops and resulting scarring wouldn't be in line for a DALK (partial-thickness transplant) anyway, so anything that would rule that out in future is not a consideration.
As far as the people in case 1 are concerned - those with only mild KC, since it has not advanced beyond the very central region - one has to ask why one would go for surgery with its attendant risks when the condition is only mild and no-one knows how much it may ever progress anyway? There are more risks to surgery than rejection of a donor cornea - adverse reactions to anaesthetics, for one; infection in the incision, even foreign bodies falling in (!!!!) or triggering the growth of a cataract. For example. There are many people who wear contacts lenses all the time for "ordinary" short sightedness, and someone with mild KC isn't so far from those. Who'd go for surgery and its risks rather than wear contacts, when they are still at a stage they can wear fairly ordinary ones? - or even specs?
The people I can see this might be very useful for would be as a "last resort" for those people reckoned to be too allergic to risk transplanting because they'd almost certainly reject any donor tissue. This might at least buy them some time - though with the problems of fitting contacts over the result to enable decent vision, whether a medical "success" would equate with a happy patient is another matter.
Trouble iwth that is, how do you know someone is in this category before they've had a transplant and it has rejected and rejected and..... by which time they won't have their own tissue left to use. Maybe the second eye of someone who had rejection problems in the first eye??
Absence of donor tissue?? - well, maybe, but given the development of tissue donor banks, if there is really absolutely no donor tissue available in a certain area, I'd wonder whther the expertise, and the post-op medication, would be available and up to scratch either....
ANother possibility: I wonder if this technique might come into its own in future in combination with some of the stem cell techniques currently under research? - though even if these would reduce the issue to one of replacing a "flatter" piece for a "steeper" piece of now "cured" cornea, the problem of fitting a lens onto the resulting odd shape may still persist.
Rosemary
-
Matthew_
- Champion
- Posts: 814
- Joined: Thu 13 Jul 2006 3:13 pm
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and contact lenses
- Location: Gallafrey
Would I be right in assuming that any donated corneal tissue maintains some kind of physical weakness at the sutures or the periphery, regardless of it source and therefore this might be an area where KC will advance the most rapidly?
I am making a lot of assumptions but blame that on my lack on my lack of knowledge!
I am making a lot of assumptions but blame that on my lack on my lack of knowledge!
Get a life...get a dog!
Great posts Gareth, Rosemary and Matthew...
Rosemary as always a very well thought out post, i think your right in what you say, the "bumb" being moved to another place only creates a problem somewhere else!
Like i was saying... i don't think everyone could benifit, I think the doctors doing this, choose carfully the candidate and offer this method to them. I think its done mostly if there is scarring which is just covering the cornea and pupil from one side.
You are right in that the area removed is slightly bigger too.
And to add, I did also read about someone having this done in the US recently BTW.
Matthew, good question, I know Gareth will know, if anyone does! There are a lot of "if's" and "but's" ...its just the way KC is sometimes, with all the unknowns which come with it!
Rosemary as always a very well thought out post, i think your right in what you say, the "bumb" being moved to another place only creates a problem somewhere else!
Like i was saying... i don't think everyone could benifit, I think the doctors doing this, choose carfully the candidate and offer this method to them. I think its done mostly if there is scarring which is just covering the cornea and pupil from one side.
You are right in that the area removed is slightly bigger too.
And to add, I did also read about someone having this done in the US recently BTW.
Matthew, good question, I know Gareth will know, if anyone does! There are a lot of "if's" and "but's" ...its just the way KC is sometimes, with all the unknowns which come with it!
-
John Smith
- Moderator
- Posts: 1942
- Joined: Thu 08 Jan 2004 12:48 am
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and spectacles
- Location: Sidcup, Kent
Most techniques for dealing with KC start out a bit wacky, and some of them end up mainstream.
My personal opinion on this one is that it has very limited use for KCers, but would certainly be very useful for people with corneal damage to otherwise healthy corneas (such as being hit in the eye!).
Still, it's always good to discuss new ideas
My personal opinion on this one is that it has very limited use for KCers, but would certainly be very useful for people with corneal damage to otherwise healthy corneas (such as being hit in the eye!).
Still, it's always good to discuss new ideas
John
-
GarethB
- Ambassador
- Posts: 4916
- Joined: Sat 21 Aug 2004 3:31 pm
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and contact lenses
- Location: Warwickshire
My undersating is that the scarring resulting from hydrops and graft once completely heales is slightly tougher. My not be thicker, but tougher due to denser scar material.
This is why I think that in some cases post hydrops vision can improve because the scarring has a different refractive index and being slightly stiffer changes the cone shape in soe cases.
I would dearly like one of the proffesionsal here to say if my understanding is correct.
This is why I think that in some cases post hydrops vision can improve because the scarring has a different refractive index and being slightly stiffer changes the cone shape in soe cases.
I would dearly like one of the proffesionsal here to say if my understanding is correct.
Gareth
-
Andrew MacLean
- Moderator
- Posts: 7703
- Joined: Thu 15 Jan 2004 8:01 pm
- Keratoconus: Yes, I have KC
- Vision: Other
- Location: Scotland
This string got quite heated up there, but with all the heat, I am still looking for some light.
Sajeev, can you remember the title or at least some key words from the original article you read? I'm not so sure that taking off somebody's cornea rotating it slightly and sewing it back in place is such a whacky idea. My old mother used to keep turning the carpet (I am old enough to remember a time before fitted carpets).
I understand that KC seems to be a thinning of the cornea, so that it sags (a bit like my middle). If the sag is a consequence of gravity, then rotating the cornea will have the effect of allowing for the equalization of the topography.
I am not persuaded that the rotation could be a permanent or even a long term solution, but I reckon it might give a patient a year or so of useful sight before a donor graft becomes appropriate.
For all that, I still hope to see the day when we can grow our own repacement corneas.
But Sajeev and jay, never be reluctant to put your case as strongly as you feel. The only thing we ought to be careful about is not driving each other away from the forum; you both seem robust enought to be able to take and even enjoy a bit of a scrap!
Andrew
Sajeev, can you remember the title or at least some key words from the original article you read? I'm not so sure that taking off somebody's cornea rotating it slightly and sewing it back in place is such a whacky idea. My old mother used to keep turning the carpet (I am old enough to remember a time before fitted carpets).
I understand that KC seems to be a thinning of the cornea, so that it sags (a bit like my middle). If the sag is a consequence of gravity, then rotating the cornea will have the effect of allowing for the equalization of the topography.
I am not persuaded that the rotation could be a permanent or even a long term solution, but I reckon it might give a patient a year or so of useful sight before a donor graft becomes appropriate.
For all that, I still hope to see the day when we can grow our own repacement corneas.
But Sajeev and jay, never be reluctant to put your case as strongly as you feel. The only thing we ought to be careful about is not driving each other away from the forum; you both seem robust enought to be able to take and even enjoy a bit of a scrap!
Andrew
Andrew MacLean
Return to “General Discussion Forum”
Who is online
Users browsing this forum: No registered users and 38 guests