graft and cataract at the same time?

[Bipin]

I have had a corneal graft and cataract in my right eye at the same time. I could not open the eye for five days. It is 3 weeks since the op but vision is blurred. Any suggestions why it takes so long for the vision?
Has anyone in the group had both ops at the same time?

[Ali Akay]

Hi Bipin
Apart from keratoconus, the most common reason for having a corneal graft is something called Fuch's dystrophy which normally affects older people.It's quite common then to have the so called "triple procedure"- removal of cataract, insertion of an intraocular lens, and corneal graft.This is not common in keratoconus as patients are usually younger when they have graft and hence unlikely to have cataracts.As you've posted here I am assuming you have keratoconus.I am also assuming you've had the triple procedure ie sometimes it may not be possible to insert an intraocular lens due to some complication during surgery, and the vision would then be very blurred until you have a contact lens with strong power to make up for the focusing power of the cataract. If all is well, then I am afraid it's giving it more time, still early days.Make sure you don't miss your after-care appointments and ask relevant questions. There is often a fair amount of astigmatism (distortion) after a graft, and this could be exaggerated if some of the stitches are tight, etc. and could result in very blurred vision. It's obviously far too early to remove the stitches yet. When they do a refraction test (to see how much distortion there is) they'll be able to give you a better idea about the visual outcome.Make sure you take the drops religiously and if you notice any deterioration in the vision contact your consultant asap.
Take care

[Bipin]

Thanks Ali for the reply.
I had Keratoconus at the age of 21. I had LE graft in 1970 and RE in 1972. Both grafts were done at MEH.
However LE graft started giving problems and I had another LE graft in 2000.
The RE and cataract op took place on 9.6.05.
I was told that one of the side effects of usig Maxidex is cataract. I am only 55. I thought by impalnting a lens with good strength I will not need any glasses for my RE. The catarct is also developing in my LE. Maybe I will get it done once my RE settles. I am on 4 times maxidex and 4 times chloramphenicol. Both without prservatives. The drops with preservatives gives me inflammation.
I have had two grafts in each eye totalling 4 grafts so I can say I am experienced person for keratoconus.

[jayuk]

Bipin

What kind of problems did the graft give that it had to be done again?

-Jay

[Ali Akay]

Hi Bipin
You're obviously old hat at this! As you may know,before routine cataract surgery the eye is measured to determine the strength of the implant needed(biometry).Nowadays this can be done to great accuracy,but it'd be virtually impossible to get accurate biometry in your case and I suspect they have put an implant of "average" strength which means it could be quite a few dioptres out. Hopefully it's only a refractive problem and would be sorted with specs or contacts once the eye is healed properly. Your case illustrates the wisdom in delaying grafts for as long as possible as they don't last forever and there is less chance of needing a repeat graft by delaying surgery for as long as possible.However things are a lot better nowadays as they try to age-match the graft as much as possible which may not have been done with your original grafts.I am not trying to put anyone off having a graft if that's the only answer, but newly diagnosed keratoconics often ask for surgery as a quick fix without realising that it really is a last resort as you know.On a positive note it's undoubtedly the most successful transplant.

[Bipin]

Hi Jay,

I believe the corneas were drowning as they had gone very old compared to my age and I was loosing vision. I had reached a stage when it had to be done. I did wait five years before we touched the second eye. I am in good hands at MEH/ My original ops in 70's were done by Mr Noel Rice(now retired) when you had to stay in hospi for 3 weeks and could not look down. The last two were oerformed by Miss Linda Ficker at MEH.

[jayuk]

Bipin

If you dont mind me asking, over the years what has been your vision from the grafted eyes?

Which lens types have you used? Have you found the vision to be stable over many years?.....

-Jay

[Bipin]

Hi Jay

I have not used any type of contact lenses since my graft. In fact I did not need any glasses for almost seven years after the grafts in 1970's. Since then I have used only glasses. To correct my keratoconus before the graft I tried hard small contact lenses in 1968/69 as they were the only ones available. The lenses would not stay on the cornea because of the shape of the cornea.In the end I did opt for the corneal graft.
regards
bipin

[jayuk]

Bipin

That sounds like you have a very successful graft then to not have to wear glasses!!..there arent many that can say that I tell you!...I am assuming you had good vision post graft then, as opposed to not wanting to wear them due to comfort/fitting issues