UK Keratoconus Self-Help and Support Association

Hello,

This is my first post on this website, although I have spent time looking through it previously I have put off finding out more information about the operation that I will be having soon. Im 27 and have Kerataconus in my right eye and should be having an operation in Belfast near the end of September. When I met the surgeon back in March he told me that he would be attempting a DALK transplant although he said that it would be reasonably difficult in my case (he gave me a difficulty rating of 4/5). The alternative I believe would be a fully penetrating graft.

Here’s the question; Whilst at the hospital I asked to speak to someone who had gone through with the operation and I sat down with a lady that had had the DALK transplant. It all made sense and really helped me to get an idea of what is going to happen, but I don’t really know what the differences will be if the surgeon has to revert to a penetrating graft? Will the whole healing process be quite different, and can i really not walk up stairs? I believe that there is a higher chance of rejection?

I think the long and short of it is that im prepared to wake up after surgery and be told that I have had the DALK transplant but to be told I have had the penetrating one worries me somewhat.

Many thanks

Tim

Hi Tim, and welcome to the forum.

I've had both a penetrating and a DALK graft, so can compare the two for you.

DALKs do lower the risk of rejection by a fair bit - although not usually to "zero risk" unless you have freeze-dried donor tissue (to my knowledge only one consultant in the UK [at St. Georges, Tooting and in Harley St.] is licenced to do this). The healing time though is generally quicker for a PK graft, and eventual vision is usually quoted as being slightly better on average. The difference in eventual visual acquity is low though, and I'd go for the DALK as it has the lower rejection risk.

That said, if your cornea is very thin, carrying out a DALK is very difficult. You will be on the operating table for much longer, and if you have a problem with the anaesthetic then you may be better off with a PK. Certainly, I'd ask the consultant for odds on progressing from a PK to a DALK in your case. In mine, I was told that there was a 5% chance of progressing to a PK. And if I'd have had a PK, so be it.

You can certainly walk up a flight of stairs immediately after the graft; but no lifting, or strenuous exercise.

Hope this helps. Ask away if you have any more questions.

Imagine you are looking at two grapes; for the sake of the story, let's say that one is red and the other is green.

Imagine now that you have a machine that will cut a circular hole into the skin of each grape, measuring very precisely the depth of the cut.

Cut into the skin of each grape to the same depth.

Peel away the cut material and carefully place the piece you have cut from the red grape into the hole you have made in the green one, and vice versa.

The curviture of the two grapes will be different, so the fit may not be precise. If you tried to sew the new skin into the old grape you would end up with a wrinkle. That is probably the main problem with the DALK, although it does almost completely eliminate the danger of the graft rejecting.

As I understand it, the PK is actually an easier operation, but it does have some dangers associated: there is the danger of rejection and the danger during surgery of a catastrophic loss of Intra Occular Pressure.

I have had one of each My PK was followed by cataract surgery in the same eye and i now have 6/6 vision (corrected with glasses) in that eye.

My DALK is getting better, and I am waiting nearly a year later to have all 16 sutures removed. I have been told that I'll have to wear a contact lens in that eye.

Each time I accepted the advice of the surgeon, and I am grateful to him for explaining so carefully the possibilities and pitfalls of both.

All the best.

Andrew

Hi John & Andrew

Thanks for both of your replies, its good to hear from someone thats had both types of graft. Out of interest, how long does it take for your vision to settle? I assume that it will be cloudy for some time, but does it just change very slowly over the course of the year?

As for the "catastrophic loss of Intra Occular Pressure", well, it doesn't sound too appealing but i guess every operation has its dangers.

Thanks

Tim

Tim

I don't think the loss of intra occular pressure happens very often . I manged to get through my PK with no such complications, and as you say there is no such thing as risk-free surgery.

DALK takes longer to settle than PK. Beyond that, I guess the time it takes will vary from individual to individual. nearly a year after my DALK I can read the top three lines of the snellen chart with all 16 sutures in place and without any correction.

All the best

Andrew

Hi Yim i have just recentky had a dalk graft in my right eye and when i was told i would need a graft they would tryand do a dalk graft altough there was an extremly high chance they would have to convert to a pk graft during surgry and as it happend they did not convert yo a pk graft they continued with the dalk graft dispite the cells they had saved splitting open and having to be repaired during surgry or though as a result of this i had yo have a further op were they had to but a bubble in my eye to help the centre attache outside was attaching vety well. The centre accordimg to my surgeon seems to be attaching well and said he is happy for me to go back to worl when my sick note runns out which happens to be friday(had 5 weeks of as i have a very hands on job as a nursery nurse/play work and have to do loys of lifting and playing sport) and saidAlthough he siad he would now for defiant for a couple more week whether the graft was arraching in the middle or not but he must be confident it is or he would't be allowing me to go back to work although i will have to be on light duties for a while are well what a shame supose i will have to sit on my a**e and do although the at and craft. lol
Any way take care and goodluck with your graft
Kind Regards
martwoman