Been advised that i should consider this after using RGP lenses and Sclerals lenses.
The cornea is been scared from using lenses and i have a water logged problem from using Sclerals.
Any body tried this here?
Ally
Deep Lamellar Keratoplasty
Moderators: Anne Klepacz, John Smith, Sweet
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jayuk
- Ambassador
- Posts: 2148
- Joined: Sun 21 Mar 2004 1:50 pm
- Location: London / Manchester / Cheshire
Hi
Welcome to the forum!
Basically there are two methods for having a Transplant;
One - Penetrating Keratoplasty; whereby the whole thickness of the cornea is replaced with a donor cornea
two - DALK (Deep Anterior Lamellar Keratoplasty); this is where the initial layers of the cornea are replaced with donor material; and the underlying endothelium layer are left intact.
The latter is generaly used when there is not so much scarring in the cornea; and the base of the cornea is fine.
Advantages of the latter : fewer sticches, faster recovery time, virtually 0 chance of rejection.
The decision wil be made by your opthamlogogist as to the one thats suitable; but it is a very skillful procedure and many times the operation is changed to a full Penetrating Keratoplasty.
Welcome to the forum!
Basically there are two methods for having a Transplant;
One - Penetrating Keratoplasty; whereby the whole thickness of the cornea is replaced with a donor cornea
two - DALK (Deep Anterior Lamellar Keratoplasty); this is where the initial layers of the cornea are replaced with donor material; and the underlying endothelium layer are left intact.
The latter is generaly used when there is not so much scarring in the cornea; and the base of the cornea is fine.
Advantages of the latter : fewer sticches, faster recovery time, virtually 0 chance of rejection.
The decision wil be made by your opthamlogogist as to the one thats suitable; but it is a very skillful procedure and many times the operation is changed to a full Penetrating Keratoplasty.
KC is about facing the challenges it creates rather than accepting the problems it generates -
(C) Copyright 2005 KP
(C) Copyright 2005 KP
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John Smith
- Moderator
- Posts: 1941
- Joined: Thu 08 Jan 2004 12:48 am
- Keratoconus: Yes, I have KC
- Vision: Graft(s) and spectacles
- Location: Sidcup, Kent
Hello Ally,
Serious waterlogging problems with gas perm sclerals are virtually unheard of. Any complication of scleral lenses are miniscule compared to the potential complication of transplants, including DLKs. And also, there is no real evidence that corneal lenses do much to exacerbate corneal scarring. I understand that scarring due to contact lenses pales into insignificance compared to scarring consequential to the natural progression of KC.
You should consider a transplant when you are sure that the contact lens practitioners have run out of steam.
* Is your vision still reasonably satisfactory with corneal lenses, irrespective of the scarring? If it is, the scarring is being overstated.
* Are the sclerals gas permeable or PMMA?
* If PMMA, he should be refitted with RGP sclerals before any suggestion of a transplant.
* If the sclerals are gas perm, how do you describe the 'water logging' (not how does the clinic describe it)?
If it causing serious contact lens oedema, it goes beyond 'water logging', ie vascularisation. I am not saying some oedema and vascularisation never happens with gas perm sclerals, but I understand that this happens in a tiny minority of cases.
The fact remains that KC indicated corneal transplants have a very good prospect for a satisfactory outcome, but no-one will ever be able to dress up the fact that when it goes wrong it is an unmitigated disaster.
All the best,
Serious waterlogging problems with gas perm sclerals are virtually unheard of. Any complication of scleral lenses are miniscule compared to the potential complication of transplants, including DLKs. And also, there is no real evidence that corneal lenses do much to exacerbate corneal scarring. I understand that scarring due to contact lenses pales into insignificance compared to scarring consequential to the natural progression of KC.
You should consider a transplant when you are sure that the contact lens practitioners have run out of steam.
* Is your vision still reasonably satisfactory with corneal lenses, irrespective of the scarring? If it is, the scarring is being overstated.
* Are the sclerals gas permeable or PMMA?
* If PMMA, he should be refitted with RGP sclerals before any suggestion of a transplant.
* If the sclerals are gas perm, how do you describe the 'water logging' (not how does the clinic describe it)?
If it causing serious contact lens oedema, it goes beyond 'water logging', ie vascularisation. I am not saying some oedema and vascularisation never happens with gas perm sclerals, but I understand that this happens in a tiny minority of cases.
The fact remains that KC indicated corneal transplants have a very good prospect for a satisfactory outcome, but no-one will ever be able to dress up the fact that when it goes wrong it is an unmitigated disaster.
All the best,
John
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Allyoudeen Mungul
- Newbie
- Posts: 7
- Joined: Sat 09 Jul 2005 3:45 pm
Thanks for that!
Understand more than i did before!
Going to see the surgeon next week!
Ally
Understand more than i did before!
Going to see the surgeon next week!
Ally
Last edited by Allyoudeen Mungul on Tue 12 Jul 2005 4:53 pm, edited 2 times in total.
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Allyoudeen Mungul
- Newbie
- Posts: 7
- Joined: Sat 09 Jul 2005 3:45 pm
Hi all,
John, the water logging happen one summers day, though I didn’t know what was happening it felt like a pin was inserted into my eye. It was Bad!
I went to my local optician, upon examining me he sent me directly to Moorefield, they diagnosed that my eye was water logged.
After LE got better I went back to RGP and only rarely used the Sclerals. When I do use it for more that 6 hrs my LE starts hurting and goes red. I can almost feel the same pain I did before.
I recently lost my contact lenses on the RE so I have to wear the Sclerals, went to see the opticians and he said my LE is getting worse and I should consider Deep Lamellar Keratoplasty as a solution instead of getting a new LE Hard lens.
The vision is still okay with the Lenses, but everyone I’ve gone to said there is a lot of scarring.
Don’t know if the Sclerals are gas perm I will have to check, bought them about 2 years ago from Ken Pullman.
I describe the water logging (The Pain) as if a pin had been inserted in the eye or as if it had been cut.
As for the rest I am still learning what all this means, I can only say when I wear the hard lenses its ok but a lot of irritation, when I wear the Sclerals it’s eventually murder! Although the fit itself is comfortable.
Going to the Lister Hospital next week for a consultation.
Ally
John, the water logging happen one summers day, though I didn’t know what was happening it felt like a pin was inserted into my eye. It was Bad!
I went to my local optician, upon examining me he sent me directly to Moorefield, they diagnosed that my eye was water logged.
After LE got better I went back to RGP and only rarely used the Sclerals. When I do use it for more that 6 hrs my LE starts hurting and goes red. I can almost feel the same pain I did before.
I recently lost my contact lenses on the RE so I have to wear the Sclerals, went to see the opticians and he said my LE is getting worse and I should consider Deep Lamellar Keratoplasty as a solution instead of getting a new LE Hard lens.
The vision is still okay with the Lenses, but everyone I’ve gone to said there is a lot of scarring.
Don’t know if the Sclerals are gas perm I will have to check, bought them about 2 years ago from Ken Pullman.
I describe the water logging (The Pain) as if a pin had been inserted in the eye or as if it had been cut.
As for the rest I am still learning what all this means, I can only say when I wear the hard lenses its ok but a lot of irritation, when I wear the Sclerals it’s eventually murder! Although the fit itself is comfortable.
Going to the Lister Hospital next week for a consultation.
Ally
Last edited by Allyoudeen Mungul on Tue 12 Jul 2005 4:51 pm, edited 1 time in total.
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Allyoudeen Mungul
- Newbie
- Posts: 7
- Joined: Sat 09 Jul 2005 3:45 pm
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Ali Akay
- Optometrist
- Posts: 201
- Joined: Thu 09 Jun 2005 9:50 pm
- Keratoconus: No, I don't suffer from KC
- Vision: I don't have KC
- Location: Hertfordshire, UK
Hi Ally
It certainly sounds like you've had hydrops.The proper medical term for "water logged" is oedema which means water logged! ie the cornea loses its transparency due to having excessive amount of water.If you've had your sclerals from Ken Pullum they would almost certainly be gas permeable as that is his speciality.It seems that you'll need a corneal graft due to excessive scarring.I wouldn't worry too much about the type of transplant,you'll have to leave it to your surgeon's discretion.As Jay pointed out, DALK has certain benefits over conventional full thickness graft, but you may not be suitable if there's a lot of scarring and you've had hydrops.
It certainly sounds like you've had hydrops.The proper medical term for "water logged" is oedema which means water logged! ie the cornea loses its transparency due to having excessive amount of water.If you've had your sclerals from Ken Pullum they would almost certainly be gas permeable as that is his speciality.It seems that you'll need a corneal graft due to excessive scarring.I wouldn't worry too much about the type of transplant,you'll have to leave it to your surgeon's discretion.As Jay pointed out, DALK has certain benefits over conventional full thickness graft, but you may not be suitable if there's a lot of scarring and you've had hydrops.
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