Here we go again

[Sweet]

Yes i can fully relate to the problems with having a DALK in that your vision takes a long time to get better. Mine is hardly any different and almost six months on i still don't notice anything.

The only good thing i have heard about having so many stitches removed early is that only being a partial graft there is a tendency for it to heal faster so maybe they are all coming out at the right time. It will just take a lot longer for it all to flattern out and for me to see better.

Hehe patience i know!

Sweet X x X

[Andrew MacLean]

John

All the best with your specs and subsequent consultant's appointments.

This is a difficult time for you, we all know. But for those of us who may have DALK proposed, your experience is one of the things we'll have to take into account.

Andrew

[John Smith]

Thanks Andrew. As for Sweet, It hadn't sunk in that your vision is not really different to your pre-op vision all those months ago.

Were you told that this is normal for a DALK graft? Really hope that things get better for you soon.

[Per]

Thanks Andrew. As for Sweet, It hadn't sunk in that your vision is not really different to your pre-op vision all those months ago.

Were you told that this is normal for a DALK graft? Really hope that things get better for you soon.

Dalk graft, is that when the donor cornea is sewn on top of the diseased cornea? As the fashion is to KC - patients with Downs Syndrome?

[Andrew MacLean]

Not quite, Per.

Let me quote an article from Netherlands Institute for Innovative Ocular Surgery (http://www.niioc.nl/edalkcrs/edalk1.htm)

"Deep anterior lamellar keratoplasty is a surgical procedure in which a maximum of diseased corneal stroma is replaced by donor tissue. Commonly, the anterior stroma is incised with a trephine that can be set to a depth not exceeding the corneal thickness, and several stromal layers may be dissected until the desired depth of the recipient bed is obtained. Lamellar dissections, for example in lamellar keratoplasty, are generally made by removing stromal tissue layer for layer, while the depth of the dissection is judged by the changing tissue structure with deeper stromal beds.

Compared to a penetrating keratoplasty, a lamellar procedure has the advantage of avoiding most complications associated with open sky surgery, easier postoperative management, and less risk of allograft rejection and other long-term complications. Despite these benefits, surgeons commonly perform a penetrating keratoplasty for anterior corneal disorders, because the latter technique is easier to perform, and lamellar transplants often show decreased best corrected visual acuity due to irregular astigmatism and/or scarring at the donor-to-recipient interface. Less scarring may occur with deeper, i.e. smoother keratectomies, and techniques such as air injection in, and hydrodelamination or photoablation of the posterior stroma have been advocated to obtain a deep recipient stromal bed." End Quote

Penetrative keratoplasty (which I think is an ordinary graft) and DALK both seem to have associated problems, but some people think that DALK has distinct advantages that outweigh the problems.

This is why it is good that John and others share their experience with us all. for my part I remain unclear about the precise advantages for the post graft patient, although I can see that it may be attractive to some to avoid "open sky" surgery where the dangers seem to include the catastrophic loss of IOP ( intra-ocular pressure).

Line somebody once said, "If you are not worried, it is because you are ill informed."

Andrew

[John Smith]

I will of course be sharing my experiences, but it is yet by no means certain that I will have a DALK graft. It could also be a "traditional lamellar" or another penetrating graft.

Until I've been seen by Mr. Rostram, I've no idea!

[Andrew MacLean]

The main thing, John, is that when you have that meeting with the man holding the knife, you have the best information available, so that you can make an informed choice!

I tend to favour the tried and tested Penetrative Graft, but as we know this is also not without its potential problems.

Meantime braver souls than I do adventurous things. They are the people who will potentially bequeathe a legacy of advance that may see corneal grafts becoem a distant memory!

Andrew

[GarethB]

The thing about DALK is that if there is deep tissue scarring, the procedure then goes for the penetrating keratoplasty.

So even if you are going for DALK, you can end up with the whole shooting match. Just depends what the surgeon finds once the process is started.

[Per]

Line somebody once said, "If you are not worried, it is because you are ill informed."

Andrew

Hehe, defensive attitude there, Andrew. Some also say if you worry that a rock will fall down on your head, you will spend your time in worries until, finally, the rock comes down:)

I have had a graft for several years, never occoured to me there were so many dangers until I started reading here and elsewhere about it.

[John Smith]

Indeed; my initial suggestion of DALK was surrounding the much lower risk of rejection, considering the experiences I've had with my right eye.

I could end up with a Penetrating graft for better vision, as I know that DALK doesn't give as good vision as PK, despite it's clear benefits in non-rejection.

I could even end up opting for refractive surgery on my right eye and leaving the left alone!

Like most of us, I'm after the best all-round general vision in the shortest time with the least complications. I'm sure that one day, that won't be a pipe dream; but until then...

As you say Andrew, you can only go into these things when you're fully armed with the facts. And that is why I feel that the KC Group and sites such as this one are invaluable.