Having to receive Corneal graft?

[sketch]

I am having unfortunately to have a graft on my left eye and also the cross linking on my right. I am fortunate enough to have private cover - BUPA and was wondering if anyone has gone through the experience in having to choose where, what hospitals are best etc. To say I am nervous is an understatement.
Does the cross linking improve vision any, because I have been to look at a clini - accuvision and they say they can reshape the cornea during cross linking? Is this correct or a sales pitch?

[Andrew MacLean]

Welcome to the forum, and congratulations on having found a private health insurance provider who covers keratoconus. We have had some members who have become exasperated at the exclusion clause on many policies that refuse to cover KC because they insist that it was a condition that pre-existed the policy.

Actually, we all have to choose our hospital. Even on the NHS we have a choice of where to go and an absolute right (some would say obligation) to insist on a referral to another hospital if we are unhappy with the place to which we are first referred.

My choice was to go to a hospital in Glasgow, although I live now in another part of west central Scotland.

Every good wish.

Andrew

[Anne Klepacz]

Hi Sketch and welcome,
Health insurance will certainly cover a corneal graft but I'm not sure about crosslinking as this quite a new procedure in this country. Have BUPA said they will cover it?
The purpose of crosslinking is to stop the progress of KC rather than to improve the vision. But the very new procedure that Accuvision are offering is designed to improve the vision as well. This procedure has been the subject of some clinical trials at Moorfields, though I don't think the results are out yet.
All the best
Anne

[GarethB]

What Accuvision are proposing is a process known as T-CAT. This an Advanced Topography Guided (T-CAT) laser treatment. Which involves removing upto 50 micronsof the cornea to provide a more regular shape folowed by cross linking to strengthen the cornea again. Further vision correction is provided by contact lenses or phakic implants.

I know Moorfields are looking at the cross linking, but unaware that they are experimenting with the T-CAT process which as far as I know is only done by Accuvision in the UK. In some cases, the cross linking has had to be repeated as corneal thining has progressed after the T-CAT and first cross linking porcess. The literature from Accuvision also makes it clear that any remaining optical defect may be corrected by contact lenses or phakic intra-occular implantation.

The Accuvision literature does make it clear that 'At present the long term effects of the keratoconus treatment are unknown'. I know in the US there is concenr about laser treatment on any eye, so much so that the FDA and US forces are carrying out an investigation in laser eye surgery due to the number of people that have gone on to develop Post LASIK ectasia which is very similar to KC.

The best combined treatemnt for KC I have seen so far is the cross linking / intacs combination, the people I have met that have had this treatment either have no need for vision correction or can wear low power glasses. The vain ones wear over the counter daily disposable contact lenses, so this might be a treatment option you might like to condiser.

[Lynn White]

Hi Sketch,

All of the above is excellent information. What I would add as a optometrist who has followed the progress of many post CXL patients, is that whatever type of cross linking you have, you may suffer vision fluctuations for weeks or months afterwards. So the timing of these procedures is a big issue. If you have a graft and CXL in the other eye at about the same time or separated by only a few weeks, you may end up with a period of time where neither eye has enough clear, stable vision for you to be able to work, drive etc. Grafts can take up to 18 months to settle and there is no guarantee that you will be able to see without a contact lens afterwards.

I am also working with one patient who still has no reliable vision in her T-CAT eye several months post surgery. I do have others who settled after a few weeks and are fine..,. but you cannot really guarantee any of this and you do have to be prepared for long settling times - as in how would you cope if this did happen?

Lynn

[sketch]

Thanks all for the above. I now have a date for dec 7th to do the graft. Rather forboding now as I have a date but still I like the surgeon and I think that has alleviated some fears. Though I am a designer and need to drive so am rather concerned about the recovery time, but i suppose there is not much I can do about that.
Once again thank you all for the comments.

Regards

[xloz69x]

I have also been told might need to have grafts possibly just on the one eye, I have to go back to hospital 27th Oct to try few other things but if they dont work then Im getting refered for graft. Am slightly worried about recovery time etc as I work in an office and need to be able to see computer etc, has anyone recently had grafts and can tell me a bit more about it please. Thanks

[Andrew MacLean]

Welcome to the forum

If your graft is only on one eye, and the other eye is working normally, then there should be no difficulty about your being back at work after the normal recovery time following surgery. This usually works out at about four to six weeks.

All the best

Andrew

[xloz69x]

im assuming its just the one eye as my doctor said if both eyes were like the right one it would be fine and we wouldnt be thinking this way. I didnt imagine it would be 6 weeks off work ! Just a little naive about the whole thing i thought it would be maybe a week off work two at most. Im just a little confused about the whole thing to be honest. We hadnt even started talking about this kind of thing until my last appointment. Just seems to now be happening all at once. Thank you for the speedy reply also. It deffo helps to come on here and speak to other peopel, i handt realised this forum was here, glad i found it though.

[Andrew MacLean]

Most eye surgeons want you to stay off work after surgery at least until you have had your first post-op clinic (usually about 4 weeks). Sometimes they want another week or two after that. The problem is that many of us at work find our IOP rising, and when your new cornea is held in place simply by some sutures, that would be dangerous; then there is the potential problem of infections etc.
You will probably be given a little list of things you can do and things that you should avoid. I liked being told not to bend over; this meant that when I dropped things somebody else had to pick them up. Sadly, that stricture did not survive my early post op clinics so I had to start picking things up again for myself.