Hello KC Chums!
Ok to cut a very very long story short... Will Scar tissue formation with in the cornea stop KC progressing?
That is the "contention" say two independant Surgeons who know about scar tissue formation by cutting in to the cornea, from there own experiance (the experiance part is very important)
When asked does corneal thinkness of the cornea increase after "cuts" in to the cornea?
Yes it does... so in a thinning disorder that must be a bless to have!
Now i don't know if you guys have ever experianced a Dr really focusing on what you was saying and then going to their medical book shelf and start looking up things for you, photo coping things for you and spending hours with you about KC!!
...well this has happened quite a few times and have spent some very fine after noons just chatting drinking tea ...and out of one of the times came a study, which i have the long version of in the form of a hard copy with pictures.
The short version is here.
Please comment guy's in how you "read" this study... i'm interested in knowing your comments without commenting myself first.
Cheers
RK causing KC?
Moderators: Anne Klepacz, John Smith, Sweet
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John Smith
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Well, to me this reads as though the author is suggesting that the patient has developed KC because of the radial keratometry (cuts) previously.
Ken Pullum has told us that a more correct name for KC would be "Primary corneal ectasia", so that ectasia mentioned would be what we know as KC.
However, the prior family history of KC suggests to me that there is a possibility that the patient may have gone on to suffer from KC anyway, and the cuts were a red herring.
Of course, we don't know the whole story - as in why the RK procedure was carried out in the first place...
Ken Pullum has told us that a more correct name for KC would be "Primary corneal ectasia", so that ectasia mentioned would be what we know as KC.
However, the prior family history of KC suggests to me that there is a possibility that the patient may have gone on to suffer from KC anyway, and the cuts were a red herring.
Of course, we don't know the whole story - as in why the RK procedure was carried out in the first place...
John
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Andrew MacLean
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This case represents the first documented incidence of corneal ectasia as a complication of primary RK.
Yes, John, you are right. The author clearly identifies RK and AK as causes and not potential cures of KC. The patient did also have a family history, but in his late 40's had not shown any prior sign of the development of KC, so even if his genetic make up did pre dispose him to KC, the scarring of his cornea tissue still seems a good bet as the proximate cause of his condition.
Andrew
Andrew MacLean
First of all the topic title is not one i wrote, it is not my own words ...it was added by a Mod.
Anyway, I think the word "cause" was not used in the study, and the cause of KC is not known, but what the study does show is that after RK surgery for this person studied Keratoconus was seen to come in to an RK-ed eye and this is what was noted, or if you like it showed that progression of keratoconus (possibility from pre-existing to the RK surgery) was not stopped by the scar formation of the "cuts" put on the cornea.
If Keratoconus can be caused by "cuts"/incisions then the hundreds of thousands of RK done here in the UK and world-wide would have shown this up years ago. As what you find is that RK has a lot of years of follow up data, much more than for laser and RK causing KC is not the "News" here, not at all, otherwise people would not be running around doing research on genetics and spending a lot of money on it etc.
What the "News" is in this study is that it is the first documented case of Keratoconus coming in to a RKed eye. And we know that many hundreds of thousands (if not millions around the world) of RK surgery has been done for many many years before this study has been done. RK surgery was all the rage at one time to correct vision by flatting the cornea.
So the question is where are the RK patients who have Keratoconus? Why is this the first documented one? Such late in the day? when there is so much follow up and for many years and all around the world?
I think any data can be looked at as being like a glass half empty or a glass half full, depending on your angle on things.
I don't think you can make a normal cornea in to a Keratoconic cornea... but there is an exception where just one eye getting KC after RK is deemed as its cause, not that it was the only one that had been documented! when RK was done religiously. And this study being done at the time when roughly when RK was moved a side for the arrival of laser (which thins the central part of the cornea where we see out of, which is not good for our condition)
Just my two pennies!
Anyway, I think the word "cause" was not used in the study, and the cause of KC is not known, but what the study does show is that after RK surgery for this person studied Keratoconus was seen to come in to an RK-ed eye and this is what was noted, or if you like it showed that progression of keratoconus (possibility from pre-existing to the RK surgery) was not stopped by the scar formation of the "cuts" put on the cornea.
If Keratoconus can be caused by "cuts"/incisions then the hundreds of thousands of RK done here in the UK and world-wide would have shown this up years ago. As what you find is that RK has a lot of years of follow up data, much more than for laser and RK causing KC is not the "News" here, not at all, otherwise people would not be running around doing research on genetics and spending a lot of money on it etc.
What the "News" is in this study is that it is the first documented case of Keratoconus coming in to a RKed eye. And we know that many hundreds of thousands (if not millions around the world) of RK surgery has been done for many many years before this study has been done. RK surgery was all the rage at one time to correct vision by flatting the cornea.
So the question is where are the RK patients who have Keratoconus? Why is this the first documented one? Such late in the day? when there is so much follow up and for many years and all around the world?
I think any data can be looked at as being like a glass half empty or a glass half full, depending on your angle on things.
I don't think you can make a normal cornea in to a Keratoconic cornea... but there is an exception where just one eye getting KC after RK is deemed as its cause, not that it was the only one that had been documented! when RK was done religiously. And this study being done at the time when roughly when RK was moved a side for the arrival of laser (which thins the central part of the cornea where we see out of, which is not good for our condition)
Just my two pennies!
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GarethB
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Although the link is only to an abstract, the whole article would need to be read before a proper conclusion can be made.
However if you atke the abstract at face value. Patient at time of the article was 47, RK performed 12 years earlier so age at surgery was 35.
Firstly some here with KC have reported they were diagnosed after trauma to the head/eye.
Second the gentlmans familly has a history where KC is present.
Thirdly some of the people here have been diagnosed as having KC in their thirties.
So if you put the facts together that we know from the abstract the gentlman would probably have a predisposition to KC, surgery to the eye is trauma itself and from we know of this site it is not unusual to be diagnosed with KC in your mid to late thirties.
To me and purely based on the abstract it is possible that RK was the 'trigger' in some one with a preveously unknown predisposition to KC. As to being a cause, I think from the abstract the title is completly misleading and could potentially be plain wrong.
I would be very interested in reading the full article.
However if you atke the abstract at face value. Patient at time of the article was 47, RK performed 12 years earlier so age at surgery was 35.
Firstly some here with KC have reported they were diagnosed after trauma to the head/eye.
Second the gentlmans familly has a history where KC is present.
Thirdly some of the people here have been diagnosed as having KC in their thirties.
So if you put the facts together that we know from the abstract the gentlman would probably have a predisposition to KC, surgery to the eye is trauma itself and from we know of this site it is not unusual to be diagnosed with KC in your mid to late thirties.
To me and purely based on the abstract it is possible that RK was the 'trigger' in some one with a preveously unknown predisposition to KC. As to being a cause, I think from the abstract the title is completly misleading and could potentially be plain wrong.
I would be very interested in reading the full article.
Gareth
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rosemary johnson
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Ok, hold on a minute.....
First, I agree with others: someone with a family history of KC has RK (why?) and later develops KC. There is no proof of CAUSE anywhere. The RK could have been the trauma that triggered the KC (12 years later); they could have been completely separate and he just happened to developKC anyway, according to family tradition (!), or indeed the thickening of the scar tissue made the KC take longer to make itself evident than it otherwise might bave done - ie. he was already developing KC and wouldhave known about it earlier without the thickening effect of the scar tissue.
Who knows?
But's there something I want to pick up: the idea of scar tissue thickening the cornea and being good for KC is not one unique to RK/ARK - it is also said about the possible result of a naturally-occurring hydrops (and was the reason why, once upon a time, people used to induce hydrops artificially to try to toughen the cornea with the resulting scar tissue).
But no-one says that halts the KC or stops the condition itself.
AIUI, it may stabilise the vision, so it doesn't go on getting worse for a while, or may make it easier to work with (thicker, tougher corneas easier to fit contact lenses to, and better able to tolerate them, once the scarring has settled down).
Doesn't stop the condition itself being present and keeping on beavering away...
It's a bit like coastal erosion - the Civil Defence authorities may try uilding up the beaches with piles more sand dredged from else where, or with heaps of shingle, piles of rubble, concrete blocks, etc. It doesn't stop the waves having their eroding effect, it just gives them more Stuff to have to wash away before the prom, houses, cliffs etc all collapse into the briney.
SO the scar tissue is like a pileof hardcore on the shore - keeping the wavesof KC progression occupied for a while.
Of course, some people's KC progresses more than others anyway, and for most of us, there may be fast spells and slow spells...... some people's KC even seems to stop progressing of its own accord anyway.... or at least to stay static for a period.
I don't know anyone who claims that the scar tissue actually halts or reverse the condition itself - only its apparent effects maybe.
Rosemary
First, I agree with others: someone with a family history of KC has RK (why?) and later develops KC. There is no proof of CAUSE anywhere. The RK could have been the trauma that triggered the KC (12 years later); they could have been completely separate and he just happened to developKC anyway, according to family tradition (!), or indeed the thickening of the scar tissue made the KC take longer to make itself evident than it otherwise might bave done - ie. he was already developing KC and wouldhave known about it earlier without the thickening effect of the scar tissue.
Who knows?
But's there something I want to pick up: the idea of scar tissue thickening the cornea and being good for KC is not one unique to RK/ARK - it is also said about the possible result of a naturally-occurring hydrops (and was the reason why, once upon a time, people used to induce hydrops artificially to try to toughen the cornea with the resulting scar tissue).
But no-one says that halts the KC or stops the condition itself.
AIUI, it may stabilise the vision, so it doesn't go on getting worse for a while, or may make it easier to work with (thicker, tougher corneas easier to fit contact lenses to, and better able to tolerate them, once the scarring has settled down).
Doesn't stop the condition itself being present and keeping on beavering away...
It's a bit like coastal erosion - the Civil Defence authorities may try uilding up the beaches with piles more sand dredged from else where, or with heaps of shingle, piles of rubble, concrete blocks, etc. It doesn't stop the waves having their eroding effect, it just gives them more Stuff to have to wash away before the prom, houses, cliffs etc all collapse into the briney.
SO the scar tissue is like a pileof hardcore on the shore - keeping the wavesof KC progression occupied for a while.
Of course, some people's KC progresses more than others anyway, and for most of us, there may be fast spells and slow spells...... some people's KC even seems to stop progressing of its own accord anyway.... or at least to stay static for a period.
I don't know anyone who claims that the scar tissue actually halts or reverse the condition itself - only its apparent effects maybe.
Rosemary
Nice to hear everyones views, most of them is what i was thinking ...No kidding!
Plus I was also thinking that there must have been people out there who had RK for "regular myopia" who also had "flat KC" or was predisposed of KC, or even had sub-clinic KC... which was not picked up at the time of their RK (may be topography machines was not around) ... and due to the fact they had RK, RK held back their KC? and this is why that study above is so important, as that was the "first documented case"?
OR... the fact that two things happening, the
RK & KC (the "complication") is why things was noted... as what was done to solve it (the "complication"), may have been what the study wanted to show ...in that a corneal transplant was done and that it could be done to slove the "complication".
In Intacs sugery there is an incision/cut, the "tunnel" for the Intac to go through is also roughly as deep as how far an incision/cut goes in RK surgeries and there is an incision/cut in a corneal transplants going circular 360 degrees. Does these incisions/cuts trigger KC?
I think there well could be a trigger to KC, a mechanical one prehaps, or even more elements or something else all together!?
In the study KC was seen to come in to the RK-ed eye, with ARK its done to get a better profile of the cornea after the KC had been spotted. It's very much the opposite with whats going on. However with mini-ark each incision is calculated in more detail, through using diagnostic equipment, even whilst the surgery is being conducted, so that the surgeon has more control in how long, how many, how deep, where, and when he places an incision to move/change/flatten the cone... I think this coupled with the experiance of knowing about doing this surgery on various types of cones and where they are on the cornea, from previous surgerys over time, helps the surgeons do this surgery.
The conclusion in the study above, is the same as the conclusion in the longer version, it can be brought on-line as its copy-righted.
Another thing is the time element... things going slow in getting information out, the cut off points for treatments to be a matter of course treatment etc... and during this time there will be people who want to do an elective treatment, as long as they know where things are "at" then it will either turn someone off or on to the elective treatment... it all depends...
I did ask around some Drs about this study... there was shrugs of shoulders... or that it could be!
All the best and good rememberance day.
Plus I was also thinking that there must have been people out there who had RK for "regular myopia" who also had "flat KC" or was predisposed of KC, or even had sub-clinic KC... which was not picked up at the time of their RK (may be topography machines was not around) ... and due to the fact they had RK, RK held back their KC? and this is why that study above is so important, as that was the "first documented case"?
OR... the fact that two things happening, the
RK & KC (the "complication") is why things was noted... as what was done to solve it (the "complication"), may have been what the study wanted to show ...in that a corneal transplant was done and that it could be done to slove the "complication".
In Intacs sugery there is an incision/cut, the "tunnel" for the Intac to go through is also roughly as deep as how far an incision/cut goes in RK surgeries and there is an incision/cut in a corneal transplants going circular 360 degrees. Does these incisions/cuts trigger KC?
I think there well could be a trigger to KC, a mechanical one prehaps, or even more elements or something else all together!?
In the study KC was seen to come in to the RK-ed eye, with ARK its done to get a better profile of the cornea after the KC had been spotted. It's very much the opposite with whats going on. However with mini-ark each incision is calculated in more detail, through using diagnostic equipment, even whilst the surgery is being conducted, so that the surgeon has more control in how long, how many, how deep, where, and when he places an incision to move/change/flatten the cone... I think this coupled with the experiance of knowing about doing this surgery on various types of cones and where they are on the cornea, from previous surgerys over time, helps the surgeons do this surgery.
The conclusion in the study above, is the same as the conclusion in the longer version, it can be brought on-line as its copy-righted.
Another thing is the time element... things going slow in getting information out, the cut off points for treatments to be a matter of course treatment etc... and during this time there will be people who want to do an elective treatment, as long as they know where things are "at" then it will either turn someone off or on to the elective treatment... it all depends...
I did ask around some Drs about this study... there was shrugs of shoulders... or that it could be!
All the best and good rememberance day.
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