Penetrating versus lamellar graft

[robcm]

Hi everyone

haven't posted for a long time, hope you're all good. It's 10 months since my graft and all has gone well. Now have a pair of specs for the first time in 15 years, with 6/6 vision through the graft and glasses. Still have to wear a scleral in the other side though! My surgeon wants to do a lamellar graft on the left eye, but said I may notice some difference in colour perception between the 2 grafts.

Does anyone have experience of seeing through one penetrating and one lamellar graft, or any opinions? Any advice would be appreciated,

Rob

[Susan Mason]

Hi Rob

I can't answer your question - sorry. Although was glad to hear about your graft 10 months ago and vision achieved since.
I feel I may very soon be in the came position (one graft once scleral) however the other way around.
I have recently had two episodes of hydrops in the left eye one in June and then the second in Sept - which as yet is still not healed. My consultant now feels the only way to give me any quality of vision is to graft the left eye (with a penetrating graft) this was all a bit scarry as originally when grafts were first talked about non penetrating seemed to be the preffered option.
I am now in two minds, having relied only on the right eye and a scleral lens which at best lets me see two lines down on the eye chart for so long I am so fed up with it all. Never really got used to not being able to drive and part of me feels graft now is the best thing and part of me still says no wait (other bits of me just want to curl up and die - think I may be a tad depressed again!).

Would be interested to know which part of the country you are in.

Hope all goes well and you receive a reply from a member who knows.

Susan x

[rosemary johnson]

HI Rob.
Good to hear from you again, and to hear things are going OK.
Didn't you get a scleral for the grafted eye remarkably soon post-graft? - do you still ahve it and use it?
Did you go to glasses for better vision, better tolerance or just simplicity, or....??
About colours...
Did your surgeon say WHY she (?? - IIRR) thought you might see things with a different colour-tint out of each eye?
- that is, why she thinks things will look a different colour through a DALK and a PK?
WOUld be interested to hear this....
I'm sure Andrew will chip in as he's had one of each.
Did you think things looked a different colour through the PK?
After my graft, colours seem to look more "vivid" through the grafted eye (without a lens in) - whereas my own, ungrafted, eye tends to "lose" the brightness of te colours into a general fuzzy blur without the lens in.
In particular - reds tend to appear darker through my own eye, lensless, and fade into the general background, particularly in poorer light (indoors in the evening, I mean, rather than outdoors in sunlight).
Don't think there's much difference between how colours appear between grafted eye (anked) and my own eye with a lens in.
Never tried wearing a lens in both at once.
Susan: once you have had a hydrops, you have to have a full thickness (PK) graft, because the scarring left by the hydrops is in the layer that would be left with you in a laminar (DALK) graft - and you want to get rid of the scarring.
Rosemary

[Susan Mason]

Thanks, Rosemary.

[robcm]

Thanks Susan - I live in North London and am treated at Moorfields. We all have different experiences and attitudes to treatment and i too was originally very resistant to the idea of a penetrating graft. The turning point came when i could no longer tolerate a lens for long enough to do my work satisfactorily. I then very quickly went through with the graft and thankfully haven't had any regrets. In the situation you describe of being unable to drive and depressed, i would suggest the risk/benefit ratio of surgery swings firmly in favour of surgery. Of course we all speak from our own experiences and others have had less positive results from surgery. I can only say that from my experience the graft has improved the quality of my life immeasurably.

And hi again Rosemary - well remembered about my early scleral lens fitting! Sorry to see your stormy postoperative course is still ongoing. Why haven't you worn a lens in both eyes simultaneously? The whole point for me of a graft was regaining stereoscopic vision. The graft still tolerates the lens well, but having a pair of specs gives me a lot more flexibility - eg when getting up with the kids i no longer have to fiddle with a lens for a few minutes. And it gives my eyes some much deserved rest and oxygen! Astigmatism in my graft means that everything looks a bit slanty through specs but it's certainly manageable. The acuity is actually slightly better with glasses than sclerals.

I haven't noticed colour differences between the grafted and ungrafted eyes. I think the difference with a lamellar graft is that there's an extra optical interface - it may be that the effect is more of contrast definition than colour per se. Really i just wondered whether it would be bothersome enough to plump for a PK again. I'd rather have lamellar if possible i think.

Rob

[Andrew MacLean]

Rob

I also have one eye with a PK and the other with a DALK. I can see no particular difference in the visual quality of the two eyes. My own surgeon prefers to offer DALK but my first eye had the endothelium so deeply scarred that it had to be removed along with the rest of my own cornea.

I think that DALK is now the standard graft offered on the NHS, but fortunately the surgeon can still opt to perform a PK during the operation if that is indicated.

Andrew

[rosemary johnson]

hi Rob,
IIRR, a DALK is less likely to reject, more may give more problems healing evenly. A PK may heal better evenly and more quickly but may be more likely to reject. FOr a second graft, they'd be looking out for rejection now your body is "used" to the idea of intusive foreign tissue, and may be more ready to repel boarders - and may even reject the first one.
It is not unknown for someone to be booked in for a DALK and end up with a PK with then surgeon sees the eye in detail in the theatre. Or so I understand.
I really suspect the difference is, in most cases more important tot he surgeons than the people concerned!
Not that it's going to make any differene to me - I had hydrops in both eyes, so either would have needed a PK. And, despite having been recommended one in both eyes at the first offer, and the two eyes being much of a muchness so I was invited to chose which one to do first, the other one won't ever be possible now - I'm far far too sensitive to the drugs to tolerate the drugs required for another one. IN fact, if this ever starts to reject, it will just go, because I won't be able to tolerate the drugs to turn a rejection round.
YOu asked why I hadn't ever tried to put a lens in both eyes:
Well, I haven't worn two lenses together for years, so haven't had binocular vision for years - and in fact, when I have, rarely, tried to wear 2 lenses at once in the past umpteen years, haven't been able to cope with it. SO that's nothing I've missed. I can't see well enough to drive anyway, and have no desire to play tennis.
I did think, if the graft went well, and I followed up with the other one, who knew, I might be able to think of trying to learn to drive again. Ha ha. Or at least be able to get the bike out and start cycling to work, with an eye nearest the traffic working well. Ha bloody HA blody HA! - haven't even dared to think of trying ot balance on a bike again.
At present, a not wearing the new lens at all. Well, put it like this, I've worn it about 4 times inthe last 6 months, two of those for hospital appointments.
The main problem now is that the grafted eye is sore and red most of the time because it doesn't get on with the anti=glaucoma drops, and feels to red and sore to want to be putting lenses in it anyway. SO I haven't been.
Now I've stopped the steroid drops, hoorah, at last... there is nothing anti-inflammatory to keep the reaction to the anti-glaucoma drops in check, and it rapidly got very red and sore and streaming, and sore eyelids and lots of styes.... I've cut down the glaucoma drops to (rougly!) one every other day, and hope to be able to stop them after next appointment in the glaucoma clinic. Meanwhile, haven't wanted to put a lens in at all after that latest blow-up.
In any case, last time I had the lens in the grafted eye, the world was going misty and getting rainbows round any light source after I'd had it in only two hours. WHich frankly isn't much use, given the times I want vision in that eye are when I@m out and about, and especially going out riding, and two hours wear isn't worth it - by the time I'd got to the stables, mucked out, caught and groomed and saddled up Duke, I'd have to be taking the lens out already just when I wanted it... and putting a lens into a grafted eye with no running water and all that mud is not sensible. NOw we are in the new place with better wter supply and an electric kettle to warm it and wash mud off, I've been riding in the nice arena, so not so much of a problem.
If all had gone well with the op, and the eye afterwards, I might have been trying to get binocular vision back - needless to say no help or even understanding from the hospital about this being more complicated than jsut cranking a lens in each eye and looking out of them!!!!!
But apart from the resulting antipathy to the THING, I'd not like to try the struggle of learning to cope with two eyes working at once until I had a conmofrtable eye and a thoroughly comfortable lens in it to start with.
How well it would work given how different the vision in each is, that's another matter I have yet to try out!
Meanwhile, I'm just waiting for them (at the hospital) to try to push me towards glasses for it. They've already tried suggesting them (trying to say they'r a positive) but I wasn't keen - and in fact, a good thing I didn't as the astigmatism axis moved about 0 degrees in about 3 days barely a month later!
Did tey try to steer you towards specs, or was it your choice??
- I can't afford three pairs of specs after this last 15 months, and I think the quite-strong astigmatism correction would just leave me too dizzy to gt about in them.
(3 pairs? - I'd need different ones for distance and reading, and a pair with a polarising coat for outdoors as I'm now even more light-sensitive than I was before out of the grafted eye. Even if I could get away with plain reading glasses and over-glasses polarising shades for reading out doors, I can't fit the overspecs under my jockey helmet!
Rosemary

[GarethB]

Just to add to the subject of rejection. Yes a PK has a higher risk of rejection than a DALK, that said rejection rates are quite low and if caught early can be reversed and in most cases I've heard with no long lasting effects. I know some people who have sufferd a rejection episode, had it treated and many years on and counting no further rejection.