Keratoconus Corneal Transplant Followed by Astigmatism

[eitleog]

My 19 year old son has keratoconus. It began when he was 12 and he is now 19. His left eye developed a hydrop which necessitated a corneal transplant. The transplant however is showing astigmatism, at level 14. Is there anyone else who has experienced something similar? He is feeling a bit alone in facing this as it seems relatively uncommon.

[John Smith]

Hi,

I understand that it is fairly common for astygmatism to remain (or return) after a graft.

Has your son still got his stitches in place? Tension on the stitches can cause astygmatism, which will change (either for the better, or for worse) when the stitches are removed.

[eitleog]

Yes, John, not all the stitches have come out which may account for the severe astigmatism he has developed. Could the donor lens have been astigmatic? Apparently, according to one website, in a study of 2200 regular children, one-quarter were found to have some degree of astigmatism. And, as you say, it is fairly common after a corneal transplant. The donor child was 13.

As for correction, there seem to be three techniques.

How is astigmatism corrected?

"The first involves placing one or more incisions in the steep part of the peripheral cornea. The second involves modifying the length, depth or number of incisions. The third involves implanting a special intraocular lens, called a toric lens. The latter two approaches can be combined to achieve high amounts of astigmatism correction, if necessary."

I believe they call this Astygmatic Keratotomy.

I think my boy is just very fed up with the poor luck he feels he is having with this. Others have keratoconus, but his developed a hydrop in the left eye, an exceptional event to his mind. That necessitated a corneal transplant. But, since we had been advised to wait until adulthood, he had not been focusing the muscles in the left eye for 6 years, from the age of 12 to 18. That necessitated a second painful operation to correct the muscles in the horizontal plane. That removed the double vision (diplopia) although there is still a little bit in the vertical plane. The surgeon said we may lose more than we gain if we try to fix that. So, he will have to accept that. His binocular/depth perception suffered somewhat through these operations and he has had to stop skiing which, amazingly, he did for a number of years, despite his eyes, more power to him. He has not complained much over the years and dealt with it bravely, but psychologically he has been impacted once more by the high degree of astigmatism (degree 14) which also followed the corneal transplant. The specialist will be trying something called a Dilinger lens, (can’t find it on the net) which my boy reports is one of the only things left to try, although, I would think, that if that is ineffective, they might yet try some of the techniques mentioned above. He dreads the possibility of another corneal transplant, although he knows that might one day be down the line, too.

Communication with others having similar problems would help him feel less singled out and perhaps help him cope with the situation.

Humans are called upon to show bravery, that’s for sure.

Troy

[Andrew MacLean]

It will be too soon to know whether there is going to be a permanent astygmatism until all the sutures are removed.

Once that has been done, and time has been permitted for the lens to settle down, they will assess again whether there is a permanent astygmatism.

My post graft astygmatism was steeper than his, and when the last of the sutures were removed everything settled down to more managemable proportions!

Tell him not to panic.

Andrew

[eitleog]

Thanks Andrew, that will encourage him a bit. I'll pass along the message to him as well as the message board info.

Troy

[Andrew MacLean]

Troy

That's what we're here for. Encourage him to join in. I am pretty sure that there is nothing he could have to face that has not already been part of the experience of one or more of the folk here.

Andrew

[Janet Manning]

Hi Troy,
My unaided vision post graft is worse. I have severe astigmatism in opposite planes in each eye. With one eye I see horizontal lines and with the other verticals. O.K. when I look out of both, though blurry, but odd effects with one eye at a time. e.g. picture frames with only top and bottom with one eye and only sides with the other!!!! It does amazing things for Xmas lights!!!

Do you have scleral lenses in Canada? These are very big cone shaped lenses which cover most of the eye that can normally be seen. They are very comfortable and for me correct my vision, allowing me to drive. Glasses do almost nothing for me, and in any case I can only have correction in one eye because of the contrasting prescriptions. With lenses I get correction in both eyes without feeling seasick.

Maybe you could explore this possibility for your son.
Good Luck,
Janet

[Bull]

and I can assure you this, he is NOT alone, as you can see...there are lots of us....his vision will get better, it just takes some time....take care...

[jayuk]

Troy

As his sutures havent all been removed it may not be as bad as it appears....how many has he left do you know? What kind of vision does he get from that eye now?

J

[eitleog]

Well, thank you Janet, Bull and Jayuk,

Yes, Janet, it looks like scleral lenses are available in Miami and the explanation of how they work makes sense. I found a Miami-based website at http://www.eyefreedom.com/slenses.asp so they are likely up in Canada, too. That may be another solution, something I haven’t heard of. I don’t know how many sutures are left but there isn’t much vision in the left eye for now. He returns to the clinic to have Dilinger lenses (whatever they are) tried this Monday.

I mentioned to my son that he should go online. He said, “ No.â€Â