Article Date: 8/1/2003

readers' forum
Reducing Trauma from Penetrating Keratoplasty
BY BEZALEL SCHENDOWICH, OD, FIACLE

Surgery is trauma to both the body and the psyche. Ocular surgery is even more so. This is not so difficult to understand when you consider that a large part of our lives centers around and depends upon our eyes and  visual sensory input.

Corneal transplant surgery (or penetrating keratoplasty [PK]) is one of the most traumatic ocular surgeries. While the procedure itself is over in a few hours, the recuperation and healing process can take years. Not to mention that essentially the graft-host boundary can never be as strong as a cornea that has not been cut.

You can ease your patients' PK surgical trauma through several stages of information gathering. Advise your patients to:

1. Acquire full and complete information about the procedure before surgery

2. Develop a good relationship with the surgeon and his staff

3. Know whom to turn to when they require more information

4. Understand how to help themselves recover from the trauma of surgery most comfortably and safely (for the graft)

What Patients Need to Know

To help PK patients gather the information they need, I have compiled a list of questions to serve as guide. These questions are designed to encourage surgeons and other hospital staff to work constructively with their patients rather than to "lose them between the benches," which is what often happens.

I have provided no answers to these questions. Many of the answers will most likely differ among institutions and even from case to case. It is the surgical candidate's responsibility to ask and investigate so he can reach a composed state of mind before entering the operating room.

The suggested questions are:

Advice for Post-graft Care

I have also collected some pearls of advice for the care and well being of the grafted cornea:

The National Keratoconus Foundation (NKCF) addresses many of these issues in its Corneal Transplant Surgery: A Reference Guide for Patients and their Families, which published in 2002. I recommend that practitioners distribute this guide to their pre-PK patients.

The author wishes to acknowledge members of KC-Link, which is a part of NKCF, and keratoconics@yahoogroups.com.  These currently active Internet support groups suggested many of the questions and points in this article.

 

 

Scaling System for Keratoconus

 

Many patients have serious concerns about the severity of their keratoconus. I propose the following scaling grades to help you classify keratoconus patients. I have found that in most cases this grading scale can relieve some of the psychological trauma that patients experience when they suddenly learn that their eyes are diseased.

Nearly every keratoconic patient will receive a grade of two or three out of five according to this system:

I. Spectacle correction continues to provide sufficient visual acuity

II. Eyeglasses and/or contact lenses provide adequate eyesight

III. Only contact lenses can compensate for reduced vision

IV. Pre-surgical with reduced quality of life, reduced length of continuous lens wear and significant corneal scarring.

V. Post-surgical

Dr. Schendowich is a preceptor in the Optometry Clinic at the Hadassah Academic College in Jerusalem, Israel and adjunct assistant clinical professor of Optometry of SUNY ­ Optometry based in the Optometry Clinic at the Sha'are Zedek Medical Center, Jerusalem, Israel.

 


Contact Lens Spectrum, Issue: August 2003