DALK graft query

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John Smith
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DALK graft query

Postby John Smith » Sat 04 Mar 2006 10:52 am

Well, I went for my DALK consultation yesterday, and the consultant certainly agreed that I was a suitable candidate. He did say that my cornea was very thin, and gave me the impression that sooner rather than later.

One question though for the other DALKers out there though: I was told that a freeze-dried cornea would be used, and only the middle layers of the donor cornea would be transplanted into my eye. The eyelid would then be held closed by a single stitch for 4-5 days whilst a new top layer would grow.

I don't remember any other DALKer having such a stitch. I know Sweet didn't, did anyone else?
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Postby Per » Sat 04 Mar 2006 11:21 am

Hi, John.

I did not have a DALK, but had a stitch to keep the eyelids together for three days. This procedure was not used for the first graft, however. I think the procedures are diffrerent from hospital to hospital. I any case, they want the top layer to grow.

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Postby jayuk » Sat 04 Mar 2006 11:32 am

John

I have heard this in both cases of PK and DALK. What they are essentialy trying to do is to encourage the recovery with your own superficial tissue as opposed to the the donor tissue. it MAY be a pain in the first week, but longer term its an even better solution in further reducing rejection chances..although I must say that Epithelial rejection is not very common......but is, like the others, very treatable......

However, the top layers of the cornea generally recover and seal within 3-4 days anyway...hence the lid closure..........

BUT, lol, there is another way of encouraging the top/middle layers and thats stem cell enchanced recovery...but I would suspect this will not be applicable in your case.

I would def take the steps sooner rather than later in the DALK, as if its gets too thin and results in Hydrop then then its another PK!....kinda like the situ I was in until I had the C3R to halt the thinning....

Hope that helps

J
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John Smith
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Postby John Smith » Sat 04 Mar 2006 12:14 pm

Thanks for that info chaps, I do feel a little better for that.

Of course, I am imposing a delay to the op, for reasons of TUPE, my employer is changing, and so will the insurer (from Axa PPP to BUPA). I'd much rather have the whole thing done by a single insurer, especially as it's BUPA, so I'll be hanging around until probably mid-May.

Totally agree though, a hydrops is not a club I want to join :)
John

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Postby Andrew MacLean » Sat 04 Mar 2006 4:58 pm

Johm

Thaks for raising this. As you know I am thinking about DALK, but think I'd have been alarmed if the doc had given me a story like yours. fore warned is fore armed!

All the best. It's a pain about the change of your insurer, but at least Mid may is not so far away.

Andrew
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Re: DALK graft query

Postby Knight » Sat 04 Mar 2006 6:41 pm

Yeah I've heard this mentioned, but my surgeon explained it would not be necessary [in my case] they just opted to tape my eye shut for the first 24hrs - which in my opinion is very uncomfortable but also they wanted me to start my eye drops sooner and bathe it etc, which if 'sealed' up it can clog up more and obviously applying drops is pretty much impossible - swings and roundabouts...
But keeping the eye closed is a precaution initially (and a short term concern) not only because you can feel the stitches more with the eyelids opened (right after coming home I found my eye kept closing by itself anyway because it was so sensitive to the light) but also - more important - the very top layer of tissue seals within a few days so I took a collection of supplements and vitamins to help that a long - but, I felt also more irritation with my eyelids closed the little stitch end kept rubbing the inside of my top lid... so maybe expect something similar for a few days...
I will comment, thou, after my initial consultation too, I was a prime candidate for DALK as well, and within less than 6mths later the KC had progressed to where a big question mark hung over the chances of DALK at all. What your consultant said was much the same with the cornea being very thin and it was basically a case of waiting until he did the operation if he could even achieve DALk ... as most already know under a local I had the running commentary while he did the graft and I did hear it was touch and go because it was so thin, the rest is history ... so yes, there is a time issue as well and I would advocate sooner rather than later.

Good luck
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Postby GarethB » Sat 04 Mar 2006 8:15 pm

I think one of the reasons surgeons are opting for sewing the lid shut, especially after Dalk is that the eye lid fits snugly over the incision and aids in keeping everything flat plus offering some protection.

This was done when my gran had her chateracts done and the surgeon said then it helps more than just gravity keep the incision flat. On the chatercat he made the incision at the bottom of the cornea. Hi reasoningwas the the upper lid moves more than the lower, so the upper lid would not hinder the healing process.
Gareth


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