PRK or LASEK after CXL

[Dubai Gal]

Hi all,

I had my CXL in my right (worst) eye in Jan 2008, and throughout my checkups my KC seems to reducing but my vision does not seem to be any better (about 20/100) and I only get by driving and doing things because my left eye is corrected with my glasses to 20/15. I have my 1 year check up tomorrow due to various delays and was looking into the possibiliy of PRK or LASEK to correct the refractory error (if my cornea is stable enough after the CXL) Has anyone had this done? Is this a possibilty or not recommended? My left eye seems to be getting pregressively worse and I would like to have the CXL on the left eye to stop it getting worse but I am worried that without my 'good eye' I won't be able to do anything until it properly heals so would like to get as good a correction as possible in my right eye first. I will of course talk to my Dr. tomorrow and see her opinion on the subject but just wanted to see if anyone has had this done and what was the outcome...

Thanks in advance

[dplees]

I've thought long and hard about PRK and it really seems like a huge gamble. I have also read that Dr's offering this treatment advise PRK before CXL.

One thing that I am very interested in at the moment is lens implants and I will have these if my contact lenses don't work out.. IOLS are reversible and very effective.
Here is a link to DR David Jory's site, his appears to be one of the only clincs currently offering his treatment for keratoconics


http://www.long-sight.com/menu/5Keratoconus

[Andrew MacLean]

Dubai Gal

I am so sorry to learn that your vision has not improved after CXL. I am sure it was explained to you at the time that this treatment is still considered 'experimental' in many jurisdictions, and is not yet commonly available in some. Still, you will have gone into the process with your hopes high, and it must be a blow to discover that you now need to contemplate further action.

I am puzzled that you are thinking both of PRK and LASIK. I had always understood that PRK had been replaced by LASIK.

The burden of this decision must be terrible for you, but the general advice is that you should not have laser surgery on a cornea with keratoconus. Take care not to rush into a decision that has the capacity to leave you still no better off.

Every good wish.

Andrew

[Dubai Gal]

Thanks for the replies. It's not that I am not disappointed with the effect of the CXL in my right eye, as the worst case scenario was that it stopped further progression for at least a period of time, which it has and even reduced slightly, so for me it was totally worth it. But now I am looking at options of how I can get optimal vision out of this eye as it is useless without the help of my left eye. I can feel the vision in my left eye getting worse and at my last checkup in July the KC was increasing slighlty so I really want to stop this progression asap but without a good right eye to rely on I will be stuffed and won't be able to do anything for a while.

From what I have read LASEK is a modified form of PRK but is doesn't go as deep as LASIK therfore is suitable for 'certain candidates' with KC. So if my cornea is stabilited via the CXL theoretically it should be ok to laser the astigmatic bits off and get better vision...?

I am in Dubai and had the CXL here so will ask my Dr. here what she thinks and I have just found out about a good eye Dr. from Ireland doing LASEK on KC patients here so I am going to go along to see him as well. I don't think I have anything to lose by trying as my last option is a graft which I really don't want to go down that road unless I have tried every other avenue. I am also looking into lens implannts so will ask about those too, thanks dplees, but I tried every contact lens available at the time (including Rose K) and it killed my eyes and I wanted to scratch my eyes out.

Any other thoughts on this process are welcome and appreciated.

Thanks again.

[GarethB]

LASEK to me sound very risky regardless of KC or not as it was mentioned at the Birmingham meeting at the weekend that we have a number of people who had laser surgery for short sight and later went on to develop KC. It makes wme wonder of LASEK would undo any CXL treatment so far.

I have discussed PRK with my consultant before and he said for anything other than simple short sight it is very hit and miss and does not perform this proceduer on any of his KC patients as a routine procedure as he feels the trauma could cause the KC to get worse and in the case of grafts that it has a strong chance of rejection. He would only consider it as last resort and that there was nothing to loose. I got the impression he would rather go to graft options as it would give better results quicker.

For me the first choice is to work through the many lens options first.

[private104]

I was looking at differs t surgical options and even applied to go onto a CXL trial. Fortunately I got k ocked back and had to look at lenses. Thank goodness! I can still return to surgery but in the meantime Ive got good vision with pretty ordinary lenses.

[Dubai Gal]

I have been down the 'contact lens' route for years (after being diagnosed at 16/17) and I was actually pretty pissed off at the NHS for wasting my time even though I repeatedly told them I could not wear them, as that gave the KC time to progress but then I guess CXL wasn't available at that time? I would absolutely not hesitate in getting the CXL done even though it might be considered 'experimental' as it has stopped the progression of my KC in the right eye. My only issue is the refractory error I have and how best to 'deal' with it...

[rosemary johnson]

Dear Dubaigal,
Good news that the CXL has halted the KC progress, or maybe even reversed it a bit.
Sorry to ask what sounds like a dumb question - yes, I have readyour posts! - but have you tried any contact lenses again since the CXL?
- I@m thinking, it's just possible that if the CXL has firmed up the cornea and made it any more regular, then wearing contact lenses may be possible now (particularly if the corneas are now a better firmer shape, and some of the soft lens options may give better vision now than they would before).
Similarly, has anyone actually tried to see if you can be prescribed glasses?
Rosemary

[Graeme Stevenson]

I must say that I always thought any form of Laser surgery on the cornea was a non starter for KC Sufferers.
I certainly wouldnt even consider laser surgery if I had KC. The risks are well documented and IMO far too high to take.
there are many other options of contact lenses which are improving at great pace and far less of a risk.

[Dubai Gal]

Hi rosemary, no I haven't tried any new contact lenses since I gave up with the RGPs (inc RoseK) a while ago. The problem with my eye is that there are 2 corneal 'bulges' that are either side and not central so it is very difficult for me to get a good fit. My vision is amazing with the lenses but comfort wise my eyes just cannot cope because of the lack of good fit. The lenses constantly slip from iris part of the eye from just blinking and get lodged around the edge (not ideal when driving!) Then my eye is in agony and streaming. It got to the point where I didn't even dare touch my eye at all for fear of knocking the lens. I had them changed so many times you wouldn't believe, they tried thinning the edges so there was less friction between the eyelid and the lens but it was the same, and this is before factoring in the sand and air conditioning here in Dubai! Given the location of KC I doubt I would be able to find a good fitting soft lens that would give me good vision.I thought maybe if the cornea was stabilised and thick enough they could zap off the bulges to at least allow me to find a soft lens that would fit and work. Anyway will look into all options, the fixed lenses might be a good one as there would be no problem with them slipping.

Thanks all for the input.