Keratoconus: Hari - Italy

World Exclusive: Asymmetrical Radial Keratotomy for the Treatment of Keratoconus

By Hari in Italy

Keratoconus is a curse... it drains our vision of its crispness and offers a washed-out, formless world as a constant replacement. And all the while we are taunted by the necessity to correct this imbalance... for myself, at least, the methods that were routinely offered to achieve this fell well short of the mark.

It was by chance that I came across a procedure called Mini A.R.K. (Asymmetrical Radial Keratotomy), a technique developed and refined my Dr in Rome, Italy.

Now, it goes without saying that my choice of treatment is not a popular one amongst the majority of eye specialists.

It is considered an old technique, one that a technology-obsessed, laser-guided world has moved on from.

In truth, it is a specialized progression of the R.K. (Radial Keratotomy) method that is often mistakenly referred to... a refined variant on the work of pioneering eye surgeon Fyodorov and Sato before him.

This is a debate without end; there will always be those who advocate automation over tactile surgical skill. Obviously it is not just a case of a surgeon being passed over in the wake of evolving technology, there is a myriad of other factors that set this procedure apart and aside from the others and fuels passions within the KC community.

But in my case the further I researched, the clearer it became to me that here was a surgeon-based procedure that very much warranted further examination.

You may feel that it is not necessary for me to denigrate other KC treatments or even mention A.R.K.'s inventor by name, but I do so to illustrate why I chose the path I did and because Mini A.R.K. and my Dr have become so intrinsically entwined. That is to say that the method is for the most part judged on the man rather than the science... personalities are a matter of taste, science is an equation.

I'm not an academic and have no scientific background, so I simply decided to rely on results; not published data or triple peer reviewed results but the personal testimonies of those who'd had and lived with A.R.K.

I met or wrote to as many ex-patients as I needed until satisfied... some very fine people. The outcome is that today I see where before I couldn't... that's result enough for me.

I walked into the Eye Clinic in Rome in November 2004 with nothing but the preconceptions of people whom had never met, the Dr or studied his work, and my very close friend, Mr KC.

The first day at the Eye Clinic was set aside for an intensive series of eye tests, slit lamp readings where taken, corneal thickness and topography data was gathered amongst other general examinations. Bio-cybernetic tests were completed to determine the presence of the Path. Agent and a course of treatment prescribed.

At this point, it must be made clear that the path. agent treatment and the mini A.R.K. surgery are two very different modalities. I feel they complement each other very well but they also require two different forms of understanding.

To me A.R.K. is a science of cause and effect, whereas the pathogenic agent requires an understanding of principles very uncommon to my small town New Zealand upbringing. The Dr sat in on most of these sessions, explaining exactly what was happening and offering explanations for my questions.

Where I come from, he would be called a straight shooter... a man with an enormous personality, refreshingly politically incorrect with very clear ideals, a man who is not afraid to speak out of turn and tell it like it is. I guess this can be disconcerting for some but to me it was a relief to hear some of the things that we as KCer's we would rather not... in my opinion burying your head in the sand can only lead to drier eyes!

So to the day of the operation, I have to say that I was more than a little nervous... it wasn't so much the operation, as it was the feeling that here I was standing (or laying in this case) at a point I'd been heading toward for over five years.

There I was dressed in my sexy new surgical gown in clinic's operating room... I listened as the Dr's assistant, Silvia, prepared my corneal maps and discussed the coming procedure.

Drops of anesthetic were placed in both eyes and a few moments passed as they took effect. The operation itself was quick and painless, at certain points additional corneal maps were taken and referred to.

The following explanation is courtesy of the clinic website:

Surgical Approach:

"The A.R.K. consists of performing micro-incisions respecting the optical zone as widely as possible (from 4 to 5.5 milli-meters). The incisions are made in a centripetal manner. We must:

Designate the optical zone; in A.R.K. we never go below the 4.0 optical zone: normally from 4.0 to 5.5

Specify the degrees (30° to 270°) of the treatment following the T.M.S. map

Calculate the number and the depth of incisions on the basis of the pachymetry. Decisions regarding the surgical program change according to different cases, while the surgeon's experience in the field of refractive surgery plays a fundamental part

While performing the incisions, according to our statistics, unwanted micro-perforations rarely happen and they don't normally need any treatment (rare case of suturing with 10-110 nylon suture). These micro-perforations were accidental and due to the excessive irregularity of the cornea's thickness, particularly in those cases where keratoconus was in a more advanced phase (III).

The micro-perforations had no statistically significant effect on the final result.

The normal rule is to incise no more than 80% of the thickness." 

There was a constant line of communication between both the doctor and his assistant. With every stage of the procedure, I regained a little more sight..., which was wonderful until I left the surgery that night and walked into the cold Roman night.

The headlights along Via Nazionale looked like the opening battle of some Star Wars film... massive star bursts around every one and a growing cloudiness had rolled in. I must admit that a distant voice began to ask if I'd just made the biggest mistake of my life.

The first night was extremely frustrating... as the anesthetic wore off, the painful irritation of the incisions kept me awake for most of the night. I thought that I'd never sleep but somehow I did, waking in the early hours of the morning.

I walked into the bathroom and switched on the light, the cloudiness was completely gone, the starbursts were tiny and I could see!... and I could see in detail. The cobwebs on the wall, the cracked tiles, the dirty bathroom sink... I suddenly realized just what sort of dump the hotel I was staying in really was!

The following day I returned to the clinic for a check-up... this was very straightforward without complication. I then spent three days sight-seeing  (which I was getting increasingly good at, both sight and seeing) before one last visit, then I flew home.

The initial healing process continued for about a week... my right eye took a little longer. The irritation dissipated over a few days, the eye drops that the clinic had given me helped whenever I felt the urge to rub.

The Dr had told me what to expect... He also said that the healing process worked in phases. The scar tissue that was forming to strengthen my weak cornea would form its way through three distinct stages before finishing.

To date I have experienced no real side effects. My sight has altered obviously since the initial operation, as my scars healed and cornea flattened... I personally very much see this as an evolution, a progressive treatment that takes time to reach its full potential.

I returned for a check-up after about two months. I had been told after the initial operation that my right eye may require a few further incisions... but at this first check-up, it was thought that more time was required for it to settle. So, nothing to do but add more pizza to my waistline and return again to the clinic in June.

June arrived and so did I again in Rome... This time I did have additional incisions on my right eye. It took a little longer for them to close but, by the time I flew home, all was fine.

I'm afraid I'm not the one to ask when it comes to the applied science of A.R.K., these are discussions for the professor... as I said, all I can relate to is results and, having lived with them for some months now, I'm more than happy.

I guess it comes down to expectations... if you expect to have your pre-KC sight restored, then this treatment surely has the potential to get very close but I know of no treatment that offers complete recovery... unfortunately that is the lasting legacy of KC that we may all have to live with.

All content is subject to change from first appearing and is intended as an informational series and should not be used as a substitute for medical advice.