PRK or LASEK after CXL

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rosemary johnson
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Re: PRK or LASEK after CXL

Postby rosemary johnson » Tue 10 Mar 2009 9:50 pm

Ah!
If the bulges are still there and still as prominent after the CXL, they would still be a problem.
Are they? - is there any chance they are less prominent after the CXL has thickened the cornea?????
Did you ever try scleral lenses? - if not: they look horrendous when you first see them, as they are about an inch in diameter. But the idea is, they fit well clear over the centre of the cornea, with a reservoir of tears between the inner lens surface and the cornea, so things like your lumps can be accommodated - the lens fits clear over them and the pool of tears can ajust to whatever shape it has to fit round.
As to whether the bulges can be lasered off, I guess it wuld depend on just how thick they are (and : are now) and how much would be left if the laser took them off.
You may be lucky...... but typically in KC, the worst bulgy parts are where the cornea is thinnest..... because when the cornea gets to its thinnest, that's when it most easily bulges out over the eye's own internal pressure.
A bit like a "bleb" in a tyre, if you've ever experienced one of those. The rubber starts to perish, and when you pump the tyre up, the perishing bit bulges out under teh air pressure because the rubber is no longer thick and strong enough to hold the air in and keep its shape. And at that stage, you have to spot it and think "Aha! That tyre's going" and gt a new one before you have a blow-out.
No-one can really tell without seeing your eyes - and having the specialist's expert knowledge and experience to look at them with, of course.
Hope you get some sensible and helpful advice from your specialists.
As regards sand and air con in Dubai - yup, I can imagine that! Well, I can try to. ONe day, maybe I'll get to Dubai...!
Rosemary

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GarethB
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Re: PRK or LASEK after CXL

Postby GarethB » Wed 11 Mar 2009 8:29 am

I think the K3 silicone hydrogel has been tried on children in South Africa where the cornea dips in the middle rather than bulges and if memory sereves the results were good.

I'm not near desert sand but I do work in dust environments and have found the K3 lens does not get anything underneath it and in the low humidity levels of the work environment (30% relative humidity or less) I only need to use eye drops when I first put lenses in and when I take them out. I am wearing them for 16 hours per day and 10 of those are in low humidity conditions. There is also a soft lens for iregular corneas which I've heard is quite versatile. You would have nothing to loos by trying to get your optom to get hold of some to try on you.
Gareth

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Re: PRK or LASEK after CXL

Postby lars » Sun 15 Mar 2009 10:57 am

I've had limited topography guided prk + cxl. There is a relevant thread in the forum. It's been almost a year since I had this operation and I am quite satisfied with the result.
It is a bit risky to perform this after your cxl but you should discuss this with your doctor.
A video of the operation is available on http://www.youtube.com/watch?v=WM6VgkjcHpQ.
If you want anything else, just pm me.

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Re: PRK or LASEK after CXL

Postby Dubai Gal » Sun 15 Mar 2009 11:37 am

Well I saw my regular eye Dr. (the one who did the CXL) and she said that my 'cone' has reduced 1.5D since I had it done, and it is shifting upwards from sagging underneath the central point so that it will eventually be more central and flatter (big plus for wearing lenses and getting a good fit). She brushed off the idea of PRK/LASEK without any real basis, though I am inclined to think it is because she is not in a position to be able to do it. I suggested the implantable contact lenses and she was more positive about this but said I am looking at a cost of around 20,000 UAE dirhams (about 4K pounds!). So I decided with her that I would give the Kerasoft a go (for a lovely price of around 300 pounds per lens!! How much are they in the UK?)

I then went to see the 2nd Dr. who worked with the guys in greece with the PRK and CXL and has been part of a study in Ireland with the PRK and CXL and was very positive about the experience in general. However when looking at the eye in question he said it was a -7 vision wise (eeek!!) and they would absolutely not be able to correct the full 7 in any case. He said my cornea is thick enough but he also noticed some very minor corneal scarring (not picked up by my other doc) from a previous instance of Hydrops before the CXL, it is not in my line of vision but basically it could be an indicator not to mess with the eye and 'aggravate' it further. So he said he would consult with his colleagues in Ireland and see what the general consensus was, and whether the risks of having it done would outweigh the potential benefit (given that they can't correct the full 7) but if the genral consensus is to go ahead I would more than likley have to have another session of CXL after it to strengthen it again since the laser would probably remove some of the cross linked cells. He did say my left eye was a very good candidate for PRK +CXL as I am only -2 and the KC is 'mild' but I am worried that since this eye is pretty good with my glasses (20/15) that I stuff it up...
This Dr. said that he would absolutely NOT recommend implantable contact lenses especially for a young patient, so I am going to forget those and I am going to give the Kerasoft a go in my right eye and see my vision quality and then at least get the CXL done in the left eye and wait for the verdict on the right eye.

lars, can I ask what level of KC do you have? And what the refactory errror was? Did they correct it all or just some? How long has it taken for the eye to recover (to at least the same vision it was before)? If you prefer to email me my email is njeynes(at)hotmail.com

Thx

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Re: PRK or LASEK after CXL

Postby GarethB » Sun 15 Mar 2009 2:24 pm

Most of us in the Uk get our lenses through the NHS so no matter what type of lens or the manufacturnig costs we generally pay about £52 per lens and that covers you for about a year in many cases, so if your prescription changes within a 12 month period you can get a replacemnet lesn for free. bit of a post code lottery for that one as can the type of lenses a hospital provides.

The K3 lens for my right eye is -8.5, I'll keep my fingers crossed for you that you get the same benefits from the K3 lens as I have done. I've found them to be really good in dry conditions and dust hasn't been a problem. The amount of the eye it covers and because it drapes over the cornea a bit I've found nothing gets under the lens. Dust in the eye is no worse than if I am without lenses.
Gareth

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Re: PRK or LASEK after CXL

Postby Lynn White » Sun 15 Mar 2009 7:27 pm

Hi Dubai Gal

I am glad you were told it would be difficult to do the LASIK/PRK on your cornea. I know it is common in Greece, and indeed Syria, to do this procedure after CXL but after all, you are once again weakening/thinning the cornea after just having gone through a procedure to strengthen it. I have seen cases where a perfectly normal eye of around -7.00 has had lasik and then gone on to develop keratoconus around 6 years later. We are not fully confident of the effects of CXL over time, never mind adding other procedures on top!

However, I fully understand your situation and indeed I myself routinely fit KeraSoft post CXL and know it to be successful. However, you mention these "bulges". Now, it could be that the KeraSoft will fit over these or it may be you need the newer design, the KeraSoft IC (Irregular Cornea) that can be individually designed to your corneal shape. This is not widely available yet, especially abroad, but as I am involved in the development of these lenses, I can give you an idea if this would be possible if I can have a look at your topographies.

If you want me to do this, please contact me via email - details in my signature.

Lynn
Lynn White MSc FCOptom
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Clinical Director, UltraVision

email: lynn.white@lwvc.co.uk

Dubai Gal
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Re: PRK or LASEK after CXL

Postby Dubai Gal » Sun 15 Mar 2009 7:51 pm

Thanks, I seem to remember I paid about 80 pounds for my Rose K ones, ah the convenience of the NHS. I used Sunderland Eye Infirmary which was a great hospital so sure I'd be able to get them there, maybe I'll just come home and get them fitted there ;)

Haven't ruled anything out yet but I will give the Kerasoft 3/Ic or whatever is likely to work a go but for me my issue is comfort, if I can feel them or they move then it just won't work for me as my eyes will get irritated.I don't seem to have a problem with dry eyes as my eyes just flood with tears and are constantly watery trying to flush the damn lens out!

Lynn thanks for the offer I have everything but the latest tops scanned so will try to get hold of a scanned copy tomorrow and email them to you.

Thx

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Re: PRK or LASEK after CXL

Postby ce2-batson » Thu 19 Mar 2009 8:59 am

Hi Dubaigal

I live in Dubai also and was diagnosed with KC about 4 months ago. I am a patient at Moorfields in Healthcare city and see Dr Edmondo there. I had intacs implanted 3 months ago and yesterday went for my 3 month checkup. I have always felt very comfortable with the Dr and the hospital and would definitely recommend them if you don't already go there. He told me I can have Lasek surgery in 3 months if I want it but he doesn't do the CXL as he is not comfortable with the long term effects.

I just feel very lucky to be in Dubai receiving private care as from what I can gather the experience in the UK can be more traumatic

Best of luck

Dubai Gal
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Re: PRK or LASEK after CXL

Postby Dubai Gal » Thu 02 Apr 2009 11:33 am

Just wanted to update that I have decided I am going to go ahead with the PRK/CXL. I found a really great Dr who really knew his stuff, and has the best technology on offer. He did not make a snappy decision and want to use me as guinea pig; he took my file to a recent conference and met with the people from the excimer laser manufacurer and his Irish collegues working with the PRK/CXL study there and sat with them to work out a treatment plan which would get me the best vision whilst removing the least amount of tissue. So they managed to come up with a plan that will remove all of the major surface issues, removing a max of 30 microns from my across my cornea. My cornea is a 470 thick at its thinnest point, so he seems to think this will be ok as a normal cornea is around 500, but as they will remove some of the already CXL'd tissue I will have CXL again afterwards. It will cost me 6000 Dirhams (1200 pounds) for the laser and another 6000 Dirhams for the CXL, but it will be money well spent and hopefully my medical insurance will pay for the CXL as they did last time. I am due to have it in May sometime so fingers crossed for a good result. He did stress my eyesight would not be 'perfect' but it would correct alot of the major problem areas causing me to have such bad vision. So for anyone looking into it, it is definitely an option to consider. :)

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Re: PRK or LASEK after CXL

Postby Andrew MacLean » Thu 02 Apr 2009 11:53 am

All the best

Andrew
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