Ferrara Rings Diary by Roman
I
went through the operation 5 days ago in Milan and my surgeon
was Dr. Carlo Lovisolo. I had my worse (right) eye operated first.
My pre-op UCVA was finger count at 1,5 m, BSCVA was first line
(the big E as I call it), BCVA (with special Keratoconus soft
lens) 20/40. My KC is rated as Stage III KC advanced KC.
The operation itself has been quite smooth and painless. It has
been done under local anesthetic so I was able to communicate
with surgeon and cooperate. I have been implanted Ferrara rings
of 0,30 thickness at 5 mm zone. The operation lasted about 30
min. and immediately after end of it I was released to the hotel.
The first checkup was one day after the operation and then before
my return to home i.e. 3 days after operation. First 4 days I
felt the rings in my eye but today I noticed that the feeling
of rings presence is starting to disappear. The UCVA has improved
only very slightly (finger counts at 3m) but according to 1-day
post op topography I see the astigmatism reduction (from 55D to
44-45D in average)
What
should happen now?
The rings will try to flatten the cornea, reduce the astigmatism
and myopia and reinforce the cornea to prevent or delay KC progression.
I don´t know if this procedure can stop KC (nobody even
Mr. Ferrara cannot claim it) but according to 5 years post op
results they have at their disposal they seem to be quite sure
that it delays KC progression. The cornea should fully heal after
1 month and the vision will stabilize after 3-6 months post-op.
After this period I´ll be able to asses how helpful was
the operation.
Major
risks as I see them
- rings extrusion happens approx. in 6% of all cases and happens
2-4 months after operations. The rings will be simply extruded
from the cornea as a foreign matter.
- infection (as involved after any operation)
- scars after future rings removal, rings misplacing, inadequate
rings selection (thickness) were explained to me as the surgical
error or failure (so be patient and choose the best surgeon you
will be able to find)
Disadvantages
I have experienced so far
- the most annoying disadv. is that in dark I see circles around
any light source (it is like you see those rings around light).
I hope it will improve with time but I was informed that I have
quite big pupil so I can experience this problem also in the future.
I should be patient and see what happens.
- feeling of presence of the rings - as I said it is starting
to disappear.
January 21, 2003
One
week post op status
After
one week I don´t see any major change (worse or better)
in my UCVA (I mean it seems to me the same like the 1 day after
the operation). However it is better than the pre op UCVA.
I
have experienced another problem last two days. I have a burning
feeling in the operated eye. This feeling is accompanied with
really dry eye effect in the morning after I wake up.
The
halo effect is still the same and I have consulted it with Dr.
Lovisolo. In reality this effect or ring will not disappear but
it will be reduced during the time, as the brain will simply adapt.
It should take some months to cope with the problem - this was
the explanation of Dr.
My
cornea is healing as I can see (the blood steps on the cornea
are disappearing).
January
27, 2003
Two
weeks post op status.
I
have passed topography today so I want to let you now results
so far. I can see a great movement in my eye and fortunately the
rings flatten the cornea and reduce astigmatism. Pre-op my steepest
point was around 62D and now it is 56D. The central astigmatism
has been greatly reduced.
The
burning feelings disappeared but I feel a light photophobia especially
in the morning. The halo effect reduced slightly but it is still
quite annoying in the evening. The UCVA fluctuates during the
day - best in the morning, worsening during the day and good again
past 10 pm. I cannot explain this effect. I don´t feel the
rings now at all but sometimes I can still feel the pain from
the wounded and not fully healed cornea. According to my doctor
everything is going the right way and cornea should be healed
within 2 weeks.
I
´ll update further.
Roman
February 26, 2003
Here
is the summary from my 1 month post op check up:
good
news:
- everything is looking very nice and the cornea heals as planned.
No infection, no rings displacement, further slight reduction
of astigmatism
- I have been corrected with GLASSES to 20/30 with minor double
vision but the vision was a bit fluctuating
- doctor said that my present status is far better than they expected
so I´m very glad
Bad
news:
- sometimes in the morning I can still feel some pain in my eye.
The doctor explained me that it is not a good sign as it can mean
the possible rings extrusion - although it happens only in 6%
of all cases. I was forbidden to wear even soft contact lens in
the operated eye for another 1 month. The pain can also mean that
cornea is not fully healed yet.
I
do have comparative topography map of my cornea (pre-op, 1 month
post op). I have to scan it somewhere and I will post it here
so you can see the results.
So
far I can sum up:
UCVA
and BSCVA is much better than before operation (2m finger count
uncorrected). The astigmatism is reduced. My UCVA is not good
enough to live normally of course but I have a good chance to
live normally with glasses or soft contact lenses. I still feel
slight photophobia and halo effect in the night (fortunately it
is getting better every week). As I was told the halo effect will
not be removed totally but I can bear it if I can function normally
during day. The main objective of mine is to try reducing and
then stabilizing KC at the position so that I don't have to ever
go for transplant. My major concern now is the possibility of
rings extrusion.
I
have scheduled my next eye operation on 17th March so please keep
your fingers crossed for me.
March
14, 2003
I
want to summarize my progress with Ferrara rings inserted into
my right eye two months ago.
Advantages
as I see them:
- astigmatism has been greatly reduced immediately after operation
and it is being slightly reduced every week according to the topography
results
- ring implantation resulted in better vision acuity both UCVA
and BSCVA. I haven't chance to try lenses so I cannot comment
on BCVA.
Pre-op : UCVA - finger count at 1 m, BSCVA 20/200, BCVA (soft
lens special) 20/40
Post-op 2 months : UCVA - 20/80 to 20/200, BSCVA 20/30 to 20/40
BCVA (I haven't tried yet)
I
intentionally wrote from.. to range because the vision (and mainly
UCVA) fluctuates much during day (best in the morning and past
22.00, worse during day). The BSCVA is fairly stable however.
The worse UCVA now can be also results of many drop I take now
for the cornea erosions and some infection (see below)
- one of the main advantage is that the rings are stretching the
cornea everyday and thus reduce astigmatism further. This process
lasts statistically 6 months so I can await further improvement
(hopefully).
Disadvantages
as I see them:
- the main concern of mine is a pain that I still experience.
I was afraid that the rings are trying to get out from the cornea
(rings extrusion). I visited my eye specialist 2 days ago and
she claimed that rings are at the good position and they are not
extruded. She however found out erosions on the cornea and initial
infection that may cause the pain I experienced. I have been immediately
give antibiotics, vitamins and Voltaren Ofta (I don´t know
what is it for = it is to be some kind of disinfection drops).
Right now I feel noticeable relief so I hope this was the source
of my pain. The pain caused that I was unable to be fitted even
with soft lenses (patients are usually able to wear lenses 1 month
post op)
- Vision fluctuation during day as mentioned above
- Halo effect in the evening and at night - I have to admit that
it has noticeable reduced and I was given also Alphagan drops
to cope with the problem. It is much better than after operation
but it is still present.
- Possibility of future rings extrusion - I'm most worried about
this problem. If it happens the rings will have to be removed
and then they might be re-operated 1 month after removal. The
problem is that the worse your KC is the thinner cornea gets and
they have to use thicker rings for worse KC. It is a kind of contradictory.
So
far I'm happy with the results and I hope the second eye will
be even better as it is my dominant eye and I have BCVA 20/20-20/30
with soft lens. The main purpose of this operation for me was:
- try to stop or delay KC progression (only time will show)
- try to operate normally at least during day with glasses
March
24, 2003
Positive
aspects:
- pain has greatly reduced in left eye and it really seems that
due to deeper implantation is my left eye healing quicker better
than my right eye
- erosions has partly disappeared in right eye (still in healing
process) and acute pain is now less frequent
- right eye UCVA (best one in the morning) has improved slightly
unfortunately it is very fluctuating and not stable (see below)
- I tried soft lens in right eye and has managed to wear it for
½ hour
Negative
aspects
- right eye is still not healed even though the official statistical
information and doctor's statement talked about 1 months healing
period and quick vision recovery - this is not very quick as for
me
- remaining erosions caused by rings hinder me from using even
soft lens
- vision fluctuation is immense during day (e.g. right eye 20/60
and 1 hour later 20/200 UCVA). I cannot imagine if doctors will
be able to find glasses when vision acuity fluctuates so greatly.
Sometimes one eye is better than the other and in one hour it
simply changes - my brain is quite confused and overall vision
is not very good (I'd say the same like before operations)
- halo and glare effect is unbearable for me without using drops
for pupil reducing, although the right eye is better so it seems
that it really decreases with the time but if it will disappear
completely - who knows?
- left eye UCVA seems to me the same or even little worse than
pre-op - it is a great disappointment for me. The vision is still
blurry and foggy but it is only 7 days post op. My previously
dominant eye is now worse and it is very confusing for the brain.
I hope for further improvement
- I'm upset about the "quick recovery information" given
by official materials of Ferrara rings procedure - because it
is quite possible that I could spend even 6 months at home to
wait for stabilization of vision fluctuation and all other negative
aspects. So far I'm totally unable to work and live normally.
This doesn't seem to me as quick recovery period.
- Damn I cannot watch TV or work with computer as I'd want - I
decided to learn German when having so much free time and repeat
and improve my English (May be I should included this in positive
aspects…)
Summary
note:
- so far little disappointed about present results
- preparing myself for a long stay at home (may another 3 months
if there is no major complication- in that case it could be even
more)
- I'm trying to keep my head up and trying to get back to positive
approach. At least the pain has greatly reduced.
______________________________________________________________________
April
09, 2003
I
have just returned from Milan where I passed ring removal from
my problematic right eye. The bottom ring has been extruded from
the cornea and therefore it had to be removed. The upper ring
is OK and it was left in my eye. The removal was totally painless
and quick and recovery after this procedure is nothing compared
to ring implantation. I ´ll have to wait 2-3 months for
complete cornea healing and then Dr. Lovisolo can re-implant ring
deeper into the cornea to avoid extrusion. In some cases it is
enough to have only one ring implanted so only time will show
what would be best for me.
Positive
aspects:
- this is the best news that doctor Lovisolo could tell me: According
to his (3 years) and Dr. Ferrara (8 years) experience with more
than 350 KC patients they have 100% success rate of STOPPING not
only delaying KC progress. This regards to patients with successful
implantation - I mean no ring extrusion or any other serious problems.
After the rings stabilized the cornea of those patients (3-6 months
post op) none of them have had any progress of KC from that point.
That is really most excellent news for me as this has been my
main objective.
- left eye recovery is excellent and it is completely different
from my right eye experience. Rings are properly situated and
they do a good job. Dr. Lovisolo gave my approval to try soft
contact lens. My UCVA doesn't fluctuate as much as in my right
eye and it ranges from 20/25-20/40 (20/40 is more common during
day) compared to 20/200 before operation.
- At the last check-up they have been able to correct me to 20/20
with glasses -0,5 spherical, -1,5 cylinder
- after ring removal from right eye my problems with pain and
discomfort completely disappeared
- I have learned also a great news regarding any other operation
that I may have to pass in future. Mediphacos (company producing
rings) and also Dr. Lovisolo will charge me nothing for any other
re-implantation procedure until we succeed. It is very fair policy
for any patient and I'm very grateful for such a approach
- my overall astigmatism in left eye has reduced - about 3,5D
that is great in such a short period and considering deeper implantation
of the rings
Negative
aspects:
- astigmatism in right eye has worsened due to bottom ring extrusion
and I "gained" +1,9 D, fortunately the status is still
much better than pre-op but sufficient correction with glasses
at this stage is not possible
- unfortunately very time consuming process with method "try
and see the results", but with our disease there is still
poor predictability and I really understand now that sometimes
first operation may not satisfy patient fully (as I was disappointed
few weeks ago)
- light sensitivity - I have to wear sun glasses even during normal
day (with no sunny weather). My right is has been more sensitive
so I can get better after the removal.
Summary:
- things are going excellent with my left eye
- bottom ring has been removed from my right eye as it has been
extruded
- Dr. Lovisolo claims that after successful implantation the KC
progression should STOP according to his and Dr. Ferrara experience
After
some weeks off I post further update. My left eye is excellent.
My current UCVA is 20/30 and BSCVA 20/25. I haven't tried soft
lenses yet but I await excellent results. The right eye has recovered
very quickly after removal of one segment that was being extruded.
My
present UCVA is 20/80 but it is not as sharp as with two segments
but my
BSCVA is 20/30 with sharp and clear vision, which is excellent.
Nowadays I sometimes experience only burning eye problems if I
work with computer for more than 4 hours or watch TV too long.
I have no other problems and so far I'm very satisfied with the
results. If needed I will undergo re-implantation in my right
eye but I have to wait some more months. I´ll update you
with more news later.
May 14, 2003
Yesterday
I received my first post op glasses. Left eye -1,0 spherical,
Right eye -4.0 spherical -2,5 105 degrees cylinder. As there is
quite a big difference between my eyes it will take some time
to get accustomed to this glasses. I hope I will be able to wear
them and it will not "confuse" my brain much. Anyway
things are very good for me. The problems I experience now (as
dry eyes and sometimes sore eyes after long computer work) are
related to KC as illness and not to rings implantation. I still
experience a little vision acuity fluctuation during the day but
it is only minor. As for halo effect - I don´t know as by
using drops I have completely eliminated this problem. I still
haven´t tried soft lenses.
Here
are my present results:
Left
eye: UCVA 20/30 with little double image effect, BSCVA 20/30
Right eye: UCVA 20/240 blurry vision, BSCVA 20/30 sharp and clear
I´m
curious what will be the results with soft lenses but I will wait
a bit for complete healing of corneas. It´s been now more
than 1,5 month that I´m not using any correction and I can
live quite normally. The only thing is that I don´t drive
yet as I don´t wanna risk. I have to say that so far I rate
this method as a little miracle as it has worked great for me
despite the problems I went through. The doctors really gave me
my vision back and gave me new chance to live normally. If the
rings also delay or even stop KC progress then I call it big MIRACLE.
I´ll
keep you updated.
June 10, 2003
Left
eye - the fluctuation of vision is still present during day unable
to wear glasses, as I would need at least 3 or 4 pairs. Soft lenses
still hurts in the eye may be something is wrong so I will go
for 3 months post op check up soon. The vision acuity is still
the same but is not so sharp as with lenses (it is kinda blurry)
To sum up - better then pre-op but worse than 1 month post op.
The rings have moved inside the tunnel and the cone shape has
changed
Right
eye - The fluctuation is now fairly stable ( but still present)
and this eye is getting better. UCVA is around 20/60 but BSCVA
is 20/30 sharp and clear. No pain. I´m starting to wear
soft lenses slowly in that eye. BCVA with soft lens 20/25 sharp
and clear no double vision. It seems that also one ring is doing
a fine job therefore I don´t consider re-implantation yet.
General
- no pain in right eye, sometimes pain in left eye which may indicate
some problems with my left eye
- vision fluctuation worse in left one
- photophobia has reduced when using reduced dosage of Pilocarpine
- start wearing soft lens in right - 20/25 - it is standard soft
lens no special KC design
- so far not able to get back to work - not able to drive
I´m
patiently waiting for my next week check up in Milan and I will
stay at home as long as needed because I really feel I´m
on the right way and I have to give the rings time. May be some
more months to let the things stabilize.
June 16, 2003
I
have just returned from Milan where I passed my check up. Unfortunately
the recent problems of my left eye are caused by extrusion of
bottom segment. This means that in first week of July I will have
to go for ring removal and in both eye I will have only one segment.
Another bad news is that the extrusion happened despite very deep
implantation and my surgeon was really surprised. It means that
another future re-implantation will be useless as it is highly
probable that it will happen again.
Summary
- 13.1.2003 rings implanted in right eye
- 17.3.2003 rings implanted in left eye
- 15.4.2003 bottom segment removed
- 7.7.2003 bottom segment will be removed
I´m
very sad about this fact as right now I´m not sure whether
only one ring in each eye will be able to stop or delay KC. Also
the vision acuity improvement will not be as good as with two
segments in each eye. Only time will answer my question. I have
bad luck and this KC is simply complicating my life more and more.
Roman
July 11, 2003
I
just got back from Milan where I was removed extruded bottom segment
from my left eye. Immediately after removal I felt great relief
as all problems with pain, photophobia etc. were gone. I feel
now very fine and my left eye vision is now even better than with
segment at extrusion process (but not as good as when I have two
good segments of course).
My
right eye is very interesting. My UCVA at last check up was 20/50
and BSCVA 20/25, which is excellent when you see my pre-op results.
It really seems that even one segment help me a lot. The vision
of right eye is now fairly stabilized I get my correction soon.
I
will have to wait some months for my left eye stabilization to
get proper correction. After this period I hope to get back to
work finally. I decided to wait at least 1 year to let the things
settle down and then decide if I re-implant any segments that
were extruded. If I see that my KC will be stable I will not go
for another operations.
I
will update you soon with my results with soft lenses as soon
as I try them as I find very special type of soft lenses called
IGEL SELECT KERASOFT from Ultravision, which have excellent post
graft results in UK.
I
want to update my story. It´s been a long time since my
first operation and I´m happy to announce that I feel very
well. My cornea is still not stable.....it is getting better and
better every month in both eyes. Despite the fact I have only
one segment in each eye KC is still getting better and better.
I use only glasses for my correction as I can be corrected to
20/30-20/35 with both eyes. My optician is also looking for soft
lenses. She has successfully fitted my right eye with standard
soft lens with vision acuity 20/25. My left eye still has more
astigmatism and therefore I will try soft toric lens for it next
week. Generally I feel very fine and I haven´t had any problems
since the bottom segment from my left eye was removed. I´m
really amazed by results of FR mainly if you take into consideration
that I have only one segment in each eye. I can imagine that the
results with both segments would be certainly outstanding.
Anyway,
next week I´m going to meet Dr. Ferrara who will be at a
congress in Munich. I will discuss a lot of issues about my case
and also the possibility of my future reoperations. "The
visual quality of my life" has improved greatly and my only
concern now is that KC will not be held by only one ring in each
eye (fortunately so long it seems to be exactly opposite). I´m
in contact also with one Professor from Germany who is performing
new method called collagen cross-linking method. They have excellent
results and he told me he is able to treat my eyes even with rings
inside. This could be another possibility to stop KC progression.
You should definitely take a look at the post of Stefan in Research
section about this new and very promising method. It seems to
be very cheap and without any complications. Unfortunately maximum
average KC could be treated by this method. I will discuss this
method with Dr. Ferrara as he informed me that he is developing
very similar method.
What
can I say at the end of this post? After all I have gone through
I´m very happy with my results and although my "battle"
with KC is not over I have made a huge step forward. I will watch
closely my eyes status and inform you about my progress. I think
I will take some rest before considering any other surgeries to
let the things settle down.
You
can take a lesson from my case - In December 2002 3 eye specialists
recommended me to go for corneal graft with my right eye. Now
in September 2003 I´m able to see with the same eye 20/30
with glasses and I still have my own cornea and I don´t
have to worry about any rejection. I just wanted to say that your
future is also in your hand and don´t be just passive patient.
Sometimes even doctors might be wrong. Despite there is still
no real cure for KC I can see that the research is going on and
I strongly believe the real cure will be soon discovered.
September 24, 2003
I´m
happy to say that since July things are only getting better and
better. I don´t feel any discomfort from the remaining rings
in my eyes at all. The vision fluctuation is still present (more
in left eye although at much milder stage than few months post
op) as the cornea stabilization continues. As for the complication
- I only experience halo and glare effect at night, which is perfectly
manageable by Pilocarpine drops if needed ( I would say it is
much much better now even without drops than after surgery). I
use glasses correction for almost whole day and I´ve got
also standard soft lenses for night driving. It is excellent and
I have to say I´m very happy with the results. You can´t
imagine how comfortable it is NOT to be fully reliable on contact
lenses. I have also tried soft toric lenses and they were excellent.
I just have to wait for complete stabilization of my cornea (because
of cylindrical axis). I will purchase them later.
My
BSCVA with only spherical glasses correction: L 20/30-20/35 R
20/30
My BSCVA with cylindrical glasses correction: L 20/30 R 20/20
My BCVA with standard soft lenses
: L 20/30 R 20/20
MY BCVA with soft TORIC lenses
: L 20/20 R 20/20
with
spherical glasses I sometimes experience "double image effect".
As
I say my status is improving every month. Here are the data from
my topographies for those who are interested:
Right
eye :
21.07.03
central power of eye : 53,42
KS 56.64D alfa 090
KF 51.28D alfa 130
21.08.03
central power of eye : 51,98
KS 54.99D alfa 070
KF 51.05D alfa 160
19.09.03
central power of eye : 50,44
KS 51.64D alfa 090
KF 49.54D alfa 140
Left
eye :
21.07.03
central power of eye : 55,28
KS 57.17D alfa 110
KF 46.03D alfa 000
21.08.03
central power of eye : 53,85
KS 55.95D alfa 120
KF 45.20D alfa 170
19.09.03
central power of eye : 52,93
KS 49.89D alfa 170
KF 45.69D alfa 160
You
can see the improvement for yourself. The FR really works you
should be only patient and give them a time. Surgeons in my country
are amazed by the results so far and I really think that thanks
to FR the quality of my life has improved a lot - and remember
that I have only one segment in each eye.
January 29, 2004
Things
have not changed a lot since my last post. I have been using only
glasses for the whole course of the day to correct my vision acuity
to acceptable level around 20/30. I feel excellent and having
no problems at all. Sometimes I do experience some aversion to
light but it is not so often.
My
left eye is fairly stable and I´m satisfied with it but
I have considered to pass re-operation of extruded segment from
my right eye. I was operated in Barcelona directly by Dr. Ferrara
who was teaching Spain surgeons about his technique. Surgery was
smooth and painless and to my surprise I was able to get back
to work 3 days post op. I feel no pain and no discomfort and I
was given personal guarantee from Dr. Ferrara that this segment
will NOT be extruded. I hope the segment will improve my vision
acuity and stabilize the cornea to prevent KC from progressing
I
will keep you all updated about my progress
Roman
Things
are getting better and better every week. During day when I work
with computer I mostly use NO correction as my UCVA is enough
to work. It is something unbelievable for me. I use only glasses
for driving and especially night driving. I manage halo and glare
effect with Pilocarpine 0,2% which is highly effective. I could
be able to drive without it as halo and glare would be too disturbing
I
will have to visit optometrist soon to change my glasses as the
right eye is slowly getting better and better. Left eye stays
fairly stable and there are only minor changes from time to time.
I haven´t worn any contact lenses for more than 5 months
now and I consider my results as real miracle.
If
right eye segments will remain inside I will also consider left
eye re-implantation of the segment just to improve my chances
to hold KC back and further improve UCVA. But it will take some
time to make such a decision.
After
all the problems I experienced in 2003 things has improved a lot
and my quality of life has dramatically improved. I will never
regret taking this long but so far effective journey with Ferrara
rings.
I
will try to get my latest topos soon and post them here
Take
Care
Roman
24th
June 2004
I want to update my story to let you now about my progress. When
you take a look at the data on the latest topo you will see that
cones are still changing in positive way even after such a long
time post surgery. The right eye is improving very well after
re-implantation in January of extruded segment. It seems that
the re-implantation is successful and I shouldn´t fear of
another extrusion anymore. I feel no discomfort form rings now.
I use glasses 24/7 for my correction. The vision acuity still
fluctuates during the day but I use the same three types of glasses
for more then 4 months now so it is OK for me to change them when
necessary. Fortunately during most of the day I use OS -1,5 sph
and OD -2,5 sph for my correction in work and that is excellent.
May be later on I will have to make some adjustment to my right
eye correction as the cone settles down completely. It is 1,5
year post first surgery and so far I´m happy about the results.
I hope rings will help me on long term basis as well.
If you ask me what is the major complication with my rings I would
say halo effect in night. Without using drops it would be very
uncomfortable but when I need to drive I use drops 1 hour before
driving and everything is just fine. I have NOT experienced any
infection nor any erosions like before when I used CL. My vision
is not 20/20 with glasses but despite that it is enough to live
normal life, to work and to do anything I want with glasses.
I will update again after some time.
Roman
