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TOPIC: PRK & Crosslinking in Athens, Greece - Full Story


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Date: Fri Feb 27 9:21 PM, 2009
RE: PRK & Crosslinking in Athens, Greece - Full Story
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You should ask a doctor for that zenke.
The only thing I have read is an article where dr. Seiler was sceptical about prk after cxl, it is better to do this before but I can't tell with certainty.

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KevinC

Date: Thu Apr 16 4:29 AM, 2009
LASIK, CXL, PRK
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Hello All,

This forum is great.  I've got a question concerning PRK and CXL.  First of all, my right eye had a corneal transplant in 2002.  In 2006, after a complete healing with no complications, I had LASIK on my tranplant.  I currently have 20/25 vision without correction.  I have a slight amount of astigmatism on the outer edge of my cornea which my corneal surgeon says cannot be corrected without the risk of making my vision worse, not better.  So, at night, I have a small amount of streaking off of headlights.  All in all, I'm very happy that I don't need glasses for that eye.

Now to PRK and CXL.  My corneal surgeon says that when CXL is finally approved here in the USA, I should be a good candidate for CXL and follow up PRK.  My question is "have there been any studies to support the use of PRK after CXL?"  I would love to get my other eye's KC corrected, but as it stands now, I can correct to 20/25 with a soft toric contact lens in my non-transplant eye and I have to wonder if I should leave well enough alone and not pursue the PRK.  BTW, I'm 54 and my KC in my non-transplant eye has been stable for 20 years.

Thanks,
Kevin

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Member

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Date: Sun Apr 26 8:29 PM, 2009
PRK & Crosslinking in Athens, Greece - Full Story
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Hi Kevin.
I have also performed cxl+limited topography-guided prk here in Greece.
I believe dr. Kanellopoulos is the most experienced with this.
The first article which provides details on cxl and prk afterwards is this:

http://journals.lww.com/corneajrnl/pages/articleviewer.aspx?year=2007&issue=08000&article=00027&type=abstract

From what I have discussed with the doctor, if you are sure you want the prk, it is better to perform it at the same time with cxl, because there is no reason to remove crosslinked tissue later.

What should be made clear is that this kind of prk does not intend to provide perfect vision but to make the cornea more regular so that you get better vision with glasses and lenses can be fitted more easily. We already have thin corneas, so a full prk might be risky for us.

You are at an age where kc should normally be stable but I don't know whether there is an age limit for this combination, I think I have read sth about it but I'm not sure.

You should ask your doctor whether he is aware of this treatment or you could come here and see dr. Kanellopoulos.



-- Edited by kc.greek on Sunday 26th of April 2009 07:29:55 PM

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Veteran Member

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Posts: 98
Date: Thu Aug 6 7:32 PM, 2009
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Hello guys, it is now 5 months since i did CXL only on the local hospital for my worst eye. I am relatively pleased since i can now have the RGP lens for up to 16 hours most days without it itching like crazy. The cylinder and kreadings also went down, but so far overall vison is the same as before.

My best eye is still spectacle correctable to 20/20 or close to with pretty much ghosting and stupid weird lights in the dark. At the last measurement i had a corneal thickness of that eye of around 500 microns.

My question is do you know how many microns the PRK took in your cases? In your opinion is it worth to do the PRK + CXL in hope to get rid of the ghosting, i mean a white paper with ligts on it in an otherwise dark room is glowing in my best eye :( even though i have the 20/20 vision, do you think this could be removed with PRK? How was it for you? How is it to look at a streetlight outside with the PRK + CXLed eyes?

The local hospital just only started with CXL, i was the first in the region, PRK they dont do for KC, i will try to mention articles about the combined procedure, but it is a common hospital that treats people that are close to blind and my "little ghosting" is nothing they can measure.

Thankful for any help.

Best regards Henrik

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Senior Member

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Posts: 113
Date: Fri Aug 7 9:10 PM, 2009
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dr.k and other centers use the new allegro 400hz t-cat guided software. It only removes 50 microns of tissue. It is more of a normalization technique to make the cornea more normal.In the worst case scenario you will be in a soft toric lens with most definatley 20/20 vision(or better) with less ghosting at night. One issue I encountered was because of the tissue removal the pupil gets bigger and I encountered night time disturbances different than ghosting, they are like windmills coming off light which do bug me but i use alphagen p glaucoma drops which shrink the pupil and help amazingly.Also, crosslinking can be done noe up to 320 microns,(with dr.k) so u have possibility of much more enhancement, but me myself am still weiry on situation as i am at 425 in the right and i believe am cutting it close.i am 20/25 in that eye with ghosting after correction,(soft lenses)so for a keratoconus patient it can be considered a dream.

also kevin c, there is no reason for prk if u are corrected to 20/25 in a soft toric lens although you will most likley have amazing results with dr.k. Bochner eye institute here in t.o., has cxl and is probably a 400 round trip plane ride. 2700 dollars for one eye with cxl.


-- Edited by pereira951 on Friday 7th of August 2009 08:19:55 PM

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Veteran Member

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Posts: 98
Date: Sat Aug 8 9:12 AM, 2009
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Thanks for answers, with soft silicon hydrogel i have like close to 20/20 but with glares and halos in the dark. I can if i insist get CXL for free here in sweden ( the doctors must see that KC is progressing, i think it is very slowely)

But say if i have 500 microns cant drk remove like 70 microns if he sees that it would reduce most of the ghosting, or it does not work that way? The eye doctors here say i have a small bulge in the cornea that give me the glares and ghosting.

How is the vision with pupil shrink? Do the vision get weird? Didnt know about such drops, very interesting though.

BR henrik.f



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Senior Member

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Posts: 113
Date: Thu Aug 13 12:07 AM, 2009
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the whole point of the prk is to not fix the refractive error,but to normalize the cornea so that by with lenses or spectacles you can have best vision. the 50 micron ablation is there to make the whole cornea smooth. You must contact dr.k for the details in which u ask. If u look in dominics story, there are topo's on the second page,the above ones show the day of op,and the one underneath is 4 dayst post op,u can c the whole cone is up.symetry. I an posting knew topos in my section today...best

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Anonymous

Date: Wed Nov 4 3:57 AM, 2009
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Hello, 

Thanks for the posts everyone - i just wanted to clarify, what's the minimum corneal thickness for someone that's thinking of doing CXL?


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