UK Keratoconus Self-Help and Support Association

When is a DALK procedure deemed necessary?

Background: My sister was diagnosed with KC recently, although may have had condition for many years without realising

She went to see Eye Clinic @ lcoal NHS hospital & saw first consultant who took one look at her worst eye - he had access to other test results also - and said intacs and lenses will not work and she needed a graft (DALK). He referred her on to another consultant (see 3rd below).

2nd Consultant (Private) - Said she was just in time for DALK procedure, risk of hydrops if delayed... Presumption I guess would be if DALK not done now may leak to full PK in future (more risky?)

3rd Consultant (Private/NHS) - Said she is too young for graft (aged 25) should try lenses first as own cornea is the best to have... Seems to be on the cautious side, which is not necessarily a bad thing but has created confusion as to best approach forward.

My sister has never worn lenses before (or glasses for that matter). Has small scar/tare? in the eye so is worried if lenses would aggravate that also.

Hoping to get at least one more professional view, but was wondering if anyone recommended for DALK procedure comment on at exactly what stage DALK is inevitable and would lenses have always been tried before going down the DALK route?

Thanks for any replies.

I would be asking what her vision is actually like without glasses or CL.
For example my measure is for me to have legal vision with correction to drive. This also means i can manage computer work etc.

If she has managed so far without vision correction (if she has reasonable vision) then i would be querying why they are recommending a graft of any sort. I know that grafts have their own risks, including rejection episodes etc.

I wouls personally also ask how much experience of KC the clinic/consultants have got?

As for the question what stage is DALK necessary that is different for every person who has ever need to ask that question - some have said a graft was the best thing they could ever have done, others have said that they wish they hadnt gone down that route due to problems with/after the graft.

Hi Lizb

Many thanks for your reply.

Regarding vision without aid,
"Bad Eye" - almost non existent - described as seeing through a bathroom window. Has not tried CL so not sure if they would make any diff.
"Good Eye" - Was "OK" & was using that to get by, but started giving problems recently and hence check-ups etc followed by diagnosis of KC.

1st Consultant - Speciality - Corneal and external eye disease / Corneal and pterygium surgery. Over 15 years experience of Opthalmology. Does full transplant (not DALK).

2nd Consultant - Well known surgeon - has experience of lasic treatments, corneal transplantation, intacs etc.

3rd Consultant -
Specialties:
Ophthalmology
-Refractive surgery
-Corneal and external eye disease
-Cataract surgery
Special clinical interests:Cataract surgery
-Corneal transplantation
-Laser refractive surgery
-Refractive lens exchange
-Astigmatism surgery

Research interests:
-Lamellar and endothelial keratoplasty
-Corneal wound healing mechanisms
-Visual outcome in advanced intraocular lens (IOL) implants – toric, multifocal, phakic IOL’s

I would expect each of the consultants to have some knowledge of KC to varying degrees, although obviously what they have in common is knowledge of the Corneal transplantation. I will try to get my sister to see another consultant that has experience of both KC and transplantaion (I am meaning to PM some people here but PM seems to be playing up at the moment - goes to Outbox and hangs).

Thanks again.

PM do hang until that person comes on line to collect their message if memory serves - think it caught me out once or twice in the past

Too young for DALK?

People on the forum have had successful transplant surgery at ages younger than you report.

I know that this is difficult and it is right to get different consultant opinions, but in the end this is a decision that only the patient can make.

All the best

Andrew

Being told she is "too young" is a bit odd. I'm having the DALK procedure on the 29th of August and I'm only 21.