UK Keratoconus Self-Help and Support Association

I am interested in microsurgery method called Mini A.S.R.K. (stands for Mini Asymmetric Selective Radial Keratotomy). It is conducted only by prof. Massimo Lombardi - he has a clinic in Rome, Italy. I was wandering if anybody on this forum had undergone this kind of surgery? I would like to know what effects should one expect? I have read that even 20/20 visus without correction can be achieved - but it was only one case (apart from Lombardi's reports available on his site).

There is an already existing topic concerning prof. Lombardi, but I couldn't find any info I was looking for.

Hello Kazik

Welcome to the forum.

I am afraid I don't know whether any of our users have undergone this particular treatment, although I do recall that, some years ago, there was one member of the forum who was a keen advocate of this approach.

Andrew

It is quite awkward, that this method isn't more common. At least potentially it really can improve visus to 20/20 (which most of transplants can't) and doesn't prevent future operations on the eye. The only thing is it won't stop the Keratoconus itself (I think so), but can be conducted with cross-linking.

OK, I have visited prof. Lombardi and have some more information. In professor's opinion the keratoconus is caused by a fungus - a parasite which destroys bridges between collagen structures. That results in degradation of whole cornea structure and it's conus. So the method of therapy is:
1. Kill the fungus
2. Conduct Mini A.S.R.K. procedure - it will cause cornea to implode. In keratoconus cornea is more convex and therefore thinned. When it implodes it becomes thickened. There is another important factor - when the cornea is incised, the riboflavin (used in cross-linking) can penetrate 100% of it's thickness (whereas normally it would be about 40%).
3. Cross-linking - so that destroyed collagen's bridges are reconstructed

Prof. Lombardi will agree to conduct only Mini A.S.R.K. procedure, but in his opinion fully treatment must consist both of Mini A.S.R.K. and cross-linking.
Prof. Lombardi literally guarantees that my left eye (I-II keratoconus grade) will get 20/20 visus (is there no myopia etc.) and there will be no recurrences. The bigger problem is right eye, where I have had a layer transplant and that generates "biomechanical" problems. Professor also said that there were no complications registered, apart from photophobia that may last to 3 months (when allergic reaction to riboflavin occurs, 1/50 to 1/60 patients have that kind of problem).

It is difficult for us to comment on this procedure as it is not carried out here in the UK.

I am also a little unsure about the fungal infection issue. There are studies out there comparing collagen structure between corneas that have had fungal keratitis and keratoconus and they were different. Certainly, the mainstream opinion does not accept that KC is caused by a fungal infection and in fact, there are strong genetic factors that have shown to influence KC development.

Lynn

Well, I live in Poland not Italy and still could attend visit in Rome. But You've got a point - there only one man in the world who does this method.

I am also very sceptical about fungal infection - so much, that it actually holds me from deciding on the operation. But - prof. Lombardi seems to be VERY successful when it comes to simply curing KC. His own methods seems to both cure the cause of the disease and restore perfect vision. And the therapy of micro incisions and cross-linking are quite "conventional", so it's just some ideological issues to be dealt with. I think I'm gonna let him deal with my right eye (the worse one, I use mainly left) and if his methods prove effective - the left eye as well.

Hi Kazik -- thanks for raising this very interesting topic.

The consensus of opinion is that Keratoconus is not caused by a fungal agent -- but then the precise cause hasn't been determined either. Genetics, though, are strongly implicated.

In regards to the suggested treatment approach, I'm not medically qualified so I'll leave specific comments to professionals. However, the working assumption for this course of action is that you, to quote, "Kill the fungus". The obviously flaw in this logic is that killing fungal infections isn't always that easy and there's no such thing as a single fungal infection type. There have been -- mercifully rare -- cases where what is probably drug-resistant fungal infections cannot be treated and even persist after repeated Penetrating Keratoplasty is performed. So the "proof" if I can call it that, would have to be a sequence whereby:

a) the same fungal infection (or groups of fungal infection types) is/are identified in multiple Keratoconic eyes from different patients
b) the fungal infection identified is shown to respond to drug treatment under laboratory conditions
c) the drug treatment is applied to the Keratoconus patient
d) the patent's Keratoconus stops progressing

Pending research to prove or disprove this theory along the lines of the above it will only ever be, well, a theory.

That isn't of course to say it is wrong. It's just that it's not yet proven.

Good luck,

Chris

Very few doctors it seems perform the procedure. There are only two doctors I can find that perform the surgery. They are both in Italy and from what I gather they were colleagues at one time and they both claim to have invented the "mini a.r.k." / "m.a.r.k." / "mini a.s.r.k" procedure. Seems like the surgery is just a varient of the largely abandoned RK surgery. If you research RK there are a lot of horror stories. Sometimes people didn't develop problems until years after the surgery. Also on another internet keratoconus board there are some first hand experiences on the mini ark procedure by just a couple people that seem overly hyped. From what I gather there isn't much info at all on out there. Maybe reading up on RK would be helpful to someone considering this type of surgery.

Heres a link to some videos presentations by Lombardi

http://www.youtube.com/user/lombardimas ... eos?view=0

I was thinking of something like this to get my eye fixed, but after researching for a couple days the whole thing seems really sketchy. If you watch the last few segments of the Lombardi presentation there he really does have some quirky Ideas ... something about gamma radiation seeping out of the earth and in some way causing a pathogen to get into the eye and cause the keratoconus O_O ... It really didn't make much sense and his english is very good ...

Also have been researching "Keraflex" ... gonna wait for actual data as intial patient reports I have read have not been good.

Hi Bigbird

Thanks for the information and the link. As you say, you have to evaluate any treatment option very carefully for yourself -- doing your own research can help a lot with this task which is why it is useful when people share what they know, like you've done here.

Kind regards

Chris

longhoc wrote:Hi Bigbird

Thanks for the information and the link. As you say, you have to evaluate any treatment option very carefully for yourself -- doing your own research can help a lot with this task which is why it is useful when people share what they know, like you've done here.

Kind regards

Chris

Yes you're right Chris, as with any surgical option it's 'buyer beware', and 'your mileage may vary'. I don't want to completely discount the premise of using a modified RK procedure to treat KC as there might be evidence for it ... here's maybe somewhat relevant info http://emedicine.medscape.com/article/1 ... ew#showall . This particular Dr Lombardi though, from some of his ideas really makes me wonder. He's claiming (from his website and other sources) that the KC is caused by a parasitic organism and I can't seem to find any actual evidence for this

And this statement taken from his website:

"KERATOCONUS: Our technique is the only way to permanently remove the problem of keratoconus. It is safe, conservative and decisive. And 'risk free and absolutely free of side effects in the short and long term. This is done through the elimination of the parasite that causes the disease (disease so infectious and non-genetic) and the restructuring of the damaged cornea microsurgery, able to restore the loss of thickness and visual defect caused by the disease."


Well, saying a surgical procedure is risk free and absolutely free of side effects in the short and long term ... there's a lot wrong with that. I should disclose though, that that statement is translated from Italian by ggoogle translate ... so here is the original :

"CHERATOCONO: La nostra tecnica è l'unica soluzione per eliminare in modo definitivo il problema del Cheratocono. Essa è sicura, risolutiva e conservativa. E' a rischio zero ed assolutamente priva di effetti collaterali a breve e lungo termine. Ciò avviene attraverso l'eliminazione del parassita che causa la malattia (malattia quindi infettiva e non genetica) e la ristrutturazione microchirurgica della cornea danneggiata, capace di reintegrare la perdita di spessore ed il difetto visivo causato dalla malattia."

Oh, there also seems to be a doctor in Budapest doing a procedure like the "mini ark" , but he doesn't call it "mini ark".