Astigmatic Keratotomy - help

[Joanne Poultney]

I had a graft (DALK) in October 2010. All the stitches were taken out in September 2011. I was sent to see the hospital optician in December but he failed to get any decent vision with glasses and following a topography I've been told I have a severe astigmatism (12 diopters).

Following this, the hospital doctor gave me 2 choices - 1) to go back to the optician to see if they could fit a contact lens or 2) to have further surgery to correct the astigmastism. I opted for the latter because I was so fed up with lenses by the time I had my graft.

On Thursday I have another appointment to have a "special scan" (no idea what this is!) of my cornea with a view to doing this surgery. I presume I will also get the opportunity to discuss the surgery further with the consultant (who wasn't there at my last appointment, hence I saw the doctor).

So that's the background.... is there anyone out there who has had this surgery? I would like to know the pros and cons - have I done the right thing in chosing this option?! What sort of questions should I be asking the consultant when I go back to the hospital? Does anyone know what sort of scan I'll be having?

Any help/advice would be much appreciated as I feel very much in the dark and worried that I've made the wrong decision.

Thanks everyone!
Joanne

[Jezzafletcher]

Hi Joanne - sort of similar pattern for me... Best eye deteriorating due to cataracts and possibility of complications due to KC therefore we decide to get poor eye functioning as best as possible pending deteriorating vision in better eye. Weak eye - Graft October 2010, improved (relatively as eye was useless before) vision, graft looks ok but tests in March 2011 reveal grafted cornea very misshapen (put simply ... puckering of stitches etc) - need for Keratotomy identified but need to wait for stitches to come out & cornea graft to settle, March -May 2011 notice my very limited vision deterioating, June 2011 cataract identified in grafted eye, priority to get stitches out - done November 2011, Keratotomy performed February 2012, need to leave for 3 months to settle before tackling cataract. Was it worth it? No idea. Has it made a difference... Not sure it has, do I regret any of it? No I don't because I believe it has brought me extra seeing time and if it hasn't well it was worth the try. Sorry Joanne - I have probably been no help at all - the reality is the balance between risks and possible gains... for me the possible gains outweighed the risks.
Follow your heart - you are not a guinea pig - the experts are there to advise and not decide... stay in control, it might have a scientific base to your decision but there are no definates.
Take care and happy to tell more if that will help.
Jez

[Peter Goren]

Any form of keratotomy is really dependent on the skill of the surgeon. In my opinion, there are only a few specialists in the world qualified enough to be performing these procedures, especially for keratoconus patients. It is almost impossible to decrease 12 diopters of astigmatism in one surgery. The degree of improvement depends on the type of astigmatism and the amount it can be decreased. A keratoconus patient I saw on a follow-up recently required two sugeries to decrease his cylinder from 12 diopters to about 2.5. However, he did not have a prior graft.

The special picture they are referring to is a topographic map to determine the exact shape of your cornea and the diopter values. Depending on the machine used it will also provide the corneal thickness along with a number of other parameters.

[Joanne Poultney]

Thanks for the reply Peter.

My surgeon has gone on a year long sabbatical to Australia. He was a very good surgeon who I would trust. Now there is a new consultant who I've never met and have no idea of his/her surgical capabilities.

I had a topography map done the last time I went to the hospital back in January so I'm presuming this must be some other sort of scan that I'll be having.

[Joanne Poultney]

Jez - you have very similar views to me. To have the graft in the first place is a risk but certainly one I felt was worth taking because I had nothing to lose. I'd become intollerant to my lenses so had no useful vision in that eye anyway. Even without this further surgery and without a lens I feel that there has been an improvement. This is partly why I opted for the keratotomy surgery because I feel that I have nothing to lose. If I have this surgery then there is the possibility that I can have glasses rather than contact lenses.

I wish you all the best with your eye and hope that you too end up with some useful vision out of it.

[Jezzafletcher]

Hi Joanne - it is great to hear of someone else with a similar situation/dillema and then even better to hear that they made similar choices - it does often feel like the judgement of Solomon when it comes to making decisions re surgical treatment of KC!!! The real benefit of this site is that you realise that there are people out there that you would never have met if it wasn't for this site. It can feel quite isolated even when you have lOved ones nearby - I liken having KC with the associated dillemas and feelings of isolation that you experience for those last seconds or minutes as you lay there waiting for the general anaesthetic and surgery!!!
Anyway - take care and keep us all posted!
Jez

[Joanne Poultney]

Ok so I've been to the hospital today and saw the new consultant. We had a long discusion and the outcome is that I will be having further surgery. It won't be the surgery I thought it would be as he said that that procedure isn't suitable for such a high astigmatism (he told me it's 13 not 12!). I didn't quite catch the name of the surgery but I think he called it a cornea resection. Basically he will cut a section out of the cornea, stretch it back across and put in stitches that aren't so stetchy as the ones you have with the original graft. All this will be done under a general aneasthetic.

He told me he wouldn't be able to totally get rid of the astigmatism but hopes to be able to reduce it enough so that I can have a greater choice of vision correction with either glasses or contact lenses. He said he thinks the benefits outweigh the risks in my case. I think he's right and I have have made the right choice. I dread having to go through surgery again but if things improve then it will be worth it.

[Jezzafletcher]

If it feels right - go for it Joanne. Let us know when you have a date as really want to know how it goes and will try to provide a bit of tlc afterwards.
Good luck
Jez

[Joanne Poultney]

I'm going into hospital for this proceudre to be done tomorrow!!

[Anne Klepacz]

All the very best for tomorrow, Joanne!
Anne