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|Domande e risposte sulla Mini ARK
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|Autore:||Lorenzo [ martedì 14 giugno 2005, 17:19 ]|
|Oggetto del messaggio:||Domande e risposte sulla Mini ARK|
Sul forum kcsupport ho trovato un messaggio dove il dott Abbondanza ha risposto a un a lunga serie di domande sulla Mini ARK, siccome molte sono domande che vengono tutt'ora poste ho ritenuto utile postare il messaggio:
Hi Dr. Abbondanza,
Just decided to start a new thread here and highlight some of the questions that were put your way from members in the section Mini A.R.K for KC. I know you must be very busy and don't check here often,but if you have a chance could you look over these questions and elaborate on them if at all possible. These are the questions that were put forth from members.
1) According to your "requirements" it seems to me you are able to operate KC stage I, II and even some advanced stage III cases with appropriate corneal thickness. Can you divide patients you operated in these groups and tell us the effectiveness of mini ARK at various stages ?
2) Does mini ARK prevent corneal graft in any way or worsen chance to obtain good results after graft ?
3) What is approximate reconvalescence period after surgery and when does patient see the maximum results of mini ARK (I mean when cornea tends to stabilize in average)?
4)You stated more than 800 eye operated ? Do you have any idea how many eyes altogether were operated in Italy with mini ARK (incl. Lombardi´s patients ) ?
5)What are your results about stopping KC after mini ARK ? How many cases that progressed with KC even after mini ARK ?
6) What would you as a surgeon state as major risk of mini ARK (of course excluding any risk induced by surgical error) ?
7) What happens to an eye that has been treated with the mini A.R.K. procedure if the keratoconus returns?
Why isn't it of optimum importance that you present your scientific research to the medical establishment?
These are the questions that I brought overe from that topic but I also have some questions for you...
10) Are you aware of the reasons why this procedure is not accepted by your peers,inside and outside of Italy?
11) What do you think it would take for your peers to consider this procedure appropiate for KC corneas?
I'm glad that you take the time to come on here and inform us about this procedure you have been practicing. I don't know if this will ever gain the respect of the medical community,but if it is something that could truely benefit us KC sufferers I hope you will be able to get the mediacl community to view and study your results. Thanks for your time and I hope you are able to answer some of these questions when you find time.
It's w.e. and here I am to answer you.
I operated more than 800 eyes affected by keratoconus and I can give you these data: less than 100 were I°, around 600 were II° and around 100 were early III°. I have operated some more advanced conus because these patients didn't want corneal graft.
2°) Mini ARK can't, in any way, prevent corneal graft. Mini incisions are performed in the 8 mm. central part of the cornea and, when you undergo to corneal graft, the surgeon remove the central part of the cornea for a 8.5 mm. diameter.
3°) When the Mini ARK is performed, the patient is immediately able to see with a satisfactory visul acuity. I mean that he is able to have a visul acuity much better then before surgery. The patient has a soft contact lens placed on the operated eye in order to avoid any kind of pain due to surgery. The contact lens will be removed after, approx, seven days. The corneal tissue heal slowly ( no blod vessels in it )and the scar tissue becomes stronger and stronger day after day. After ,around, 15-30 days the cornea has acquired a very satisfactory strenght and the patient can do everything and have a completely normal life. He can swim in swimming pool ( we must very carefull about mycosis )and can play soccer of football. The final outcame will be clear after around 90 days.
4°)I think that, in Italy,more than 2000 eyes have been operated with Mini ARK.
5°) I have already said that 85-90% of eyes operated with Mini ARK have obtained a long time stable corneal profile. In my hands Mini ARK has proved to be effective but, notwithstanding my care, 12 eyes didn't stabilize and I had to perform corneal graft.
6°)Mini ARK is a safe technique because we have to perform the mini incisions ( from 1.75 up to 2.25 mm. ) without exceeding 80-85% of corneal thickness. The major risk related to Mini ARK is to produce a micro perforation of the corneal stroma. When a micro perforation occurs the corneal tissue is able to seal it and there are no consequences in the healing process.
Rarely, but it is due to a surgical error of the surgeon, a stitch is necessary.
7°)If the Mini ARK has been performed respecting its limits, it is not possible to have a cornea affecyed, again, by keratoconus. Sometimes I perform an enhancement to the previous surgery ,but I perform it in order to better correct the residual ametropia ( myopia or astigmatism ). Be aware that I perform Mini ARK since 1994 and the corneas operated with Mini ARK have shown stability for more than 10 years.
8°)I have never said that it is not important to present my research to the medical establishment. On the contrary I have already presented it in several international congresses and I am in contact with Eurotimes, the official scientific magazine of the ESCRS ( European Society of Cataract and Refractive Surgeon )in order to have my last updating on Mini ARK published on it. I think that it will be published within a few months.
10°)You ask my Mini ARK is not accepted by my peers, in and outside Italy. Well, I have to say that it is not completely true. Some other surgeons, in Italy and abroad, are performing Mini ARK. In Italy dr. Alberti in Milan is using it and, as I know, other surgeons perform Mini ARK but they call it with different names! If you could and go and visit the private web sites of some famous ( in Italy and abroad )surgeons, you could read that they, speaking about keratoconus, affirm this, " in some particular situation like early keratoconus, we can perform refractive surgery.This mean Mini ARK.
I know that many surgeon perform Mini ARK because I see, in my clinics, many patients operated with this technique who have not been operated by me. It is evident that someone has operated them!
The question should be this: why many surgeon use Mini ARK but they do not say they use it? I have not a clear answer. I can think that they are scared to say they do Mini ARK because some " big big name " in Italian ophthalmology say that Mini ARK is not good.
Anyway you are right when you say that Mini ARK in not completely accepted.
I think to have the answer.
Science is trying to give the right and " scientific " answer to many disease and science is on the right way to resolve many diseases. In order to give the same possibilities to the people living in different countries, science wants to standardize the scientific procedures. Using this scientific method many lives have been saved all over the world.
This is the good side of " scientific " method.
But there is also a bad side.
Many therapies cannot be standardized.
For example: Cancer therapy is standardized and using the same therapeutical protocol used in the U.S. or in Europe we can save a patient who is living in Vietnam where there is not a medical science advanced as in our countries.
This is good.
But, sometimes, we cannot use a different medical therapy in our hospitals because, in these hospitals, is used a therapeutical protocol and we cannot use different drugs because these hospitals are part of a trial and we must use the drugs studied in this trial.
This is not good.
Well, let's talk now about keratoconus.
Anyone in the world can use hard contact lenses, and we can study the outcame of wearing hard contact lenses on millions of people. This is good because it has allowed to produce better hard contact lenses for the people suffering for keratoconus.
But we cannot say that hard contact lenses are a therapy for keratoconus.
You know it. You know that your visual acuity is better when you wear contacts but you also know that your conus is not stabilized by contacts!
Anyone in the world can perform corneal graft. It is a standard procedure. The outcame of corneal graft is similar all over the world. You can have more astigmatism, less astigmatism, your new cornea can last for ten years ore more if the surgeon is more experienced but you cannot say that it will last for ever.
Intra corneal rings ( Intacs or Ferrara rings ) is a standardized surgical procedure. There will be little differences if the surgery has been performed in the US, in Europe or in Australia.
Mini ARK: here comes the difference. Mini ARK is not a surgical procedure easy to be standardized. When I perform Mini ARK I have to consider many factors. Age, sex, thickness on the conus apex, position of the conus apex, lenght of the eye,area affected by the conus, and many others.
I have, and I can give,some guidelines but I have to consider too, how is reacting the cornea that I am operating. I can " see " how the cornea is flattening, I can see how much the single mini incision " need " to be lenghtened or deepened.
You see, in Mini ARK is very important the " surgeon factor ".
And it is not possible to standardize the surgeon factor.
This DOES NOT mean that Mini ARK is a technique impossible to be learned.
Mini ARK requires a skilled surgeon but requires, first of all, a surgeon that really wants to learn and this mean that he must consider himself as a man who has many things to learn.
When I attend a congress I hope to ear about some new things,new surgical techniques, new drugs new future possibilities. I want to learn new things.
If, when a meeting is over, I have learnt nothing new, I am really disappointed. I have lost my time.
Mini ARK was conceived when I heard about the new mini incisions performed by professor Lindstrom in order to correct low myopia. I immediately thought that I could use this idea to correct the corneal irregularities in the keratoconus.
But I was also a surgeon skilled in the incisional surgery; I was trained in the insitute founded by professor Fyodorov in Moscow, and it was easy to me to perform these mini incisions in a cornea affected by keratoconus.
I know that many " big big names " have performed Mini ARK, in Italy, but I also know that they have abandoned it because they where not satisfied of the results. But I also know that they never asked me how to perform it! And, worst of all, they never asked me when to use and when not to use Mini ARK.
I think that these are the reasons why Mini ARK is not easyly acceptable.
Wow !! the point number ten was very very long!
11°)Here I have to say that it's my foult.
I have to go publishing and publishing and to spare, more than now, my time.
I really hope that you , Jason and all the other members, will have the patience to read this mail not one but two times because it contains, I think, many realities.
Have a nice w.e.
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