Being by the water just isn't enough :(

[John Smith]

Hi Sweet, thanks for posting that. I'm slightly less confused myself now!

I must add that for my first rejection episode, I was initially treated for herpes as the "little cluster of cells" look similar in herpes and in a surface-level rejection.

I agree that if the consultant is happy that FML 4 times a day is good enough then that's fine. He does, as Moorfields say, know what he's talking about!

Hope you're seeing better soon.

[Sweet]

Well hopefully then this is herpes and not a rejection, although am not too sure what harm that would do to a new graft either. It would be better to have nothing at all!!

Am glad that i made some sense now! Just got so dam confused myself no wonder most here did as well!!

Thanks for the support, Sweet X x X

[Andrew MacLean]

Je comprend

[John Smith]

I find this intriguing as you will be one of the first people who I know of that has had a DALK rejection! in the whole world! (however I do understand that I dont have visibility of all DALKS lol)..So I am hoping this is not the case

Jay / Sweet,

I've been spending the day editing the DVD [Don't worry, I had a friend ready to catch me when I was editing John Dart's talk ] and I've just come across a statistic that Mr. Dart announced about DALK and rejections:

In the Moorfields sample (small, admittedly) of 25 DALK grafts, one suffered from epithelial rejection. That's 4%.

It does compare very well with the figures for a penetrating graft - where 7 (28%) of the 22 PKs sampled suffered from rejection, and a shockingly high figure of 11 (50%) suffered from "rejection episodes", presumably 4 of those 11 had no further issues.

So, Sweet is not completely unique, just rather rare.

[Andrew MacLean]

Why do they report such very small samples? Is there no nationwide monitoring of outcomes?

Maybe we need a uk-wide clinical audit of ophthalmlogical outcomes. This would be hard to organize because health is organized on an individual nation basis rather than uk.

Andrew

[GarethB]

I think the only way we will get accurate figures is if the vareous eye units in the UK pool all their data.

The sample population will still be small but at least more represenative. Especially if this can anclude the number of KC patienst they have, how long since diagnoses so the true proportion that end up with grafts can be shown.

[Andrew MacLean]

Exactly. This is why I am persuaded that there needs to be a rigorous clinical audit.

On the other side, I cannot see how they can allocate resources without some way of monitoring the relative performances of didfferent eye centres.

It all just seems rather haphazard.

[Sweet]

Hehe i never said i was unique, just odd! LOL!!

It would be a good thing if units pooled all their info and we had statistics representing a wider population. Was kinda wondering though what would happen with patients like myself who move so often and get seen by so many different consultants, i would be counted a lot more than once! This would make this ?rejection a LOT bigger and mess up all the stats as names aren't used obviously. Or maybe units don't want to as they would see it as a failing if they had a lot of rejections / problems etc, but then why publish anything comes to mind if you thought like that?

Hhmm maybe too much thinking for a Sunday morning!

Sweet X x X

[GarethB]

Name is not data that would be needed, but if the data pooled included NHS patient number, that would help guard against double accounting.

It may also help when it comes to identify the general geography of KC if that is possible the way we all move about.

[jayuk]

John

Thats very interesting! Did you catch at what stage this occured?.....in terms of months?

I think the US of A will be ahead in stats as DALKs are more common their then in UK...it would be interesting to see the 3 years stats from there in terms of rejections......

However, the good thing; if I can call it a good thing, is that a Epithelial rejection is the "better" of the corneal rejections as it can be controlled and brought down very easily and quickly.....whereas the Endothelial Rejection, and even the Stroma is the B*tch From Hell !

J