Cornea transplant when is necessary

[fernando navarrete]

Hi,

I have had keratoconou for 15 years and was always told that my KC was estable I haven't change contact for the 15 years except whenever I loose one. But recently the doctor told me that I should start thinking of a corne transplant but he said the contact fit perfectly. Two years ago he said no to consider a transplant. So I saw another doctor and he said you need to have a transplant but he did not even check how my contacts fit. So I saw third doctor and this one said that since I can se 20/20 with both eyes using my gas pemeable contacs I should not get a transplant and that even my cornea is getting thing as long as I don't have problems with my vision I should keep on using my contact lenses. Does any one have a suggestion or advise. I am off course going to see another doctor.

Thanks

[jayuk]

Fernando

A few of your Docs have been right.

If you can work, see and function within your life with what you deem to be adequate; there is no reason to have a graft..AT ALL.

A graft is the absolute last resort where ALL else have failed. The are numerous lens types available today for KC corneas thus there are a number of avenues to exhaust way before a graft.

I would not consider one if I was in your position and getting 20/20.......I am assuming this is in both eyes as well?

[GarethB]

Hi Fernando,

The other thing to put in perspective is a graft can not be undone. Secondly, it is rare to get uncorrected 20/20 vision post graft and to achieve this many need glasses or RGP contacts again. Some do not achieve this post graft.

Therefore from your post I personally would see the graft option to be very unwise for the reasons Jayuk has put.

Grafts are by no means a cure, just another management strategy to be used when all else fails and there is absolutly nothing to loose.

Gareth

[fernando navarrete]

GarethB and Jayuk, Thanks for you advise I will keep on cheking that my eyes are ok but I belive that as oyu and Jayuk put it the wise thing is to wait. The pitch of the doctor that wanted to do a transplant on me is that it is easier to do it now that when the KC has progressed more but again I could get my prostate remove now so I don't have to worry about it latter, right? I read somewere that KC normally stops advancing when you are about 40 years old. Does anyone have heard something about it. I am 6 months from the finish line if that is the case!

Thanks to you I really appreciate your interest on providing advice.

[GarethB]

KC stopping at 40 is a new one on me. I know of a few people that have been diagnised with KC in their mid thirties.

Doctors also say after a graft, that is it no more KC. For most KC as such is not a propblem, but post graft issues can be long lasting for some.

Poor Visual aquity
Rejection
Need for further sight correction
KC can return as in my case.

All these are very rare.

I am very sceptical of the idea KC stopping at a predetermined time. However if your specialist has evidence to back this up and is willing to make the data available, I am happy to look at it and make an informed decission.

Having been through the graft scenario, I do not think it should be considered because the KC might get worse.

Sorry to be a bit negative, not sure how the medical system works in Mexico but if this was happening in a UK hospital I would say the surgeon was trying to find something to keep him in business.

It came up at the support group confrence that the optomotrist will keep a patient in lenses to keep themselves in work while the surgeon will alsways go for the surgical route to keep themselves in work. Really they shold be working and talking with each other to do what is best for the patient.

Sorry to be negative, but I think you have made the right choice in waiting for a graft.

Gareth

[rosemary johnson]

If you have good vision and no problems, then, as the engineers would say, "if it ain't broke, don't fix it".
Though there is a reason to do a graft sooner rather than wait: it's to do with blood vessels.
SOme people with KC get blood vessels growing across the surface of the eye and getting ever nearer to the bit of the eye you look out through.
If this happens, not only does it affect the vision - trying to see out through blood veins - but it makes it much harder to do a graft in future.
So some people have been advised to have a graft before the growing blood vessels get to the danger zone.
I don't know, obviously, if that might be the case with you, but if it is, the doctors should certainly be explaining it to you!
Rosemary

[GarethB]

Hi Rosemary,

My understandingof blood vessels growing towars the cornea is that it is due to poor oxygen transfer to the cornea so the body compensates by putting blood vessels closer. I think where this happens, it is because lenses are constantly being worn for too long and the eye is red/bloodshot most of the time. This is why optoms recomend to us not to over wear our lenses.

It is these cases that grafts may be suggested however this would not guarantee the growth of bloodvessels further so making a graft very complicated.

Post graft there is also a risk of blood vesseles growing towards the cornea as the graft heals.

The important thing for all wearing lenses is that they need to be worn responsibly as they are a managenet system for KC and so is a graft. Graft 'survival' and post graft visual aquity are extremely different things.

Post 10 years graft, there is little information, although I promote the succces of my grafts 16+ years on, my right eye is now facing problems in that KC has returned in the ungrafted part. I am lead to beleive this is quite rare, but with so litttle information post 10 years it is impossible to say if I am representative of those post 10 years graft.

Many post graft still need lenses so irresponsible lens wear can again cause blood vessels to grow to the cornea.

As Rosemarry says don't fix what aint broke. However if it is being suggested to be due to blood vessels growing to the cornea, fully investigate the cause and get that dealt with. I am sure if caught early enough it can be treated and is not a reason for a graft.

Grafts carry a slight risk, but with only a slight change in circumstances, they can become very risky. That is why further operation on my eye will only happen when it is so bad, any failure will not reduce my sight to what it is at the point of operation.

KEEP LENS WEAR SENSIBLE; NEVER WEAR A LENS IF IT HURTS; NEVER ALLOW THE EYE TO GET RED WHILE WEARING LENSES.

All are signs of problems, I would rather be partially or permanently with poor sight than permanently with no sight at all.

Grafts ALWAYS to be reserved until after ALL other optins are exhausted.

Gareth