Lasik Eyes Surgery - Neurotrophic keratitis

Author

Neurotrophic keratitis

Tabby

2005-07-30, 11:52 am

http://www.ncbi.nlm.nih.gov/entrez/...4&dopt=Citation
Ophthalmologe. 2005 Jan;102(1):7-14.

[Neurotrophic keratitis]

Cursiefen C, Seitz B, Kruse FE.

Augenklinik mit Poliklinik, Friedrich-Alexander Universitat
Erlangen-Nurnberg, Erlangen. claus.cursiefen@augen.imed.uni-erlangen.de

Neurotrophic keratitis is a degenerative disease of the cornea caused
by reduced corneal innervation. Trauma, tumors, inflammatory lesions
and surgical procedures can damage the first branch of the trigeminal
nerve on its entire course from brainstem to and within the cornea.
Loss or reduction of corneal innervation leads to a reduced aqueous
phase of the tear film and due to reduced supply with
neurotransmitters/trophic factors also to reduced epithelial healing
capacity (impaired mitosis and migration). Combined existence of tear
film deficiency and impaired epithelial healing capacity predispose to
persistent epithelial defects, corneal ulcers and perforation. Early
diagnosis and adequate treatment may prevent this catastrophic chain of
events.
__________________

Avoiding surgical procedures on the cornea would be a good start toward
preventing this catastrophic chain of events! Read the findings below.
If you have had LASIK, you have permanent patholotic (disease) changes
in your corneas.

Perhaps neurotrophic keratitis explains the degeneration of keratocytes
in the stroma of 100% of post-LASIKs

http://www.ncbi.nlm.nih.gov/entrez/...4873&query_hl=1

Cornea. 2005 Jan;24(1):92-102.

Pathologic findings in postmortem corneas after successful laser in
situ keratomileusis.

Kramer TR, Chuckpaiwong V, Dawson DG, L'Hernault N, Grossniklaus HE,
Edelhauser HF.

Emory Eye Center, Emory University, Atlanta, GA 30322, USA.
Theresa_Kramer@emoryhealthcare.org

PURPOSE: To examine the histologic and ultrastructural features of
human corneas after successful laser in situ keratomileusis (LASIK).
METHODS: Corneas from 48 eyes of 25 postmortem patients were processed
for histology and transmission electron microscopy (TEM). The 25
patients had LASIK between 3 months and 7 years prior to death.
Evaluation of all 5 layers of the cornea and the LASIK flap interface
region was done using routine histology, periodic acid-Schiff
(PAS)-stained specimens, toluidine blue-stained thick sections, and
TEM. RESULTS: In patients for whom visual acuity was known, the first
postoperative day uncorrected visual acuity was 20/15 to 20/30. In
patients for whom clinical records were available, the postoperative
corneal topography was normal and clinical examination showed a
semicircular ring of haze at the wound margin of the LASIK flap.
Histologically, the LASIK flap measured, on average, 142.7 microm
(range, 100-200). A spectrum of abnormal histopathologic and
ultrastructural findings was present in all corneas. Findings at the
flap surface included elongated basal epithelial cells, epithelial
hyperplasia, thickening and undulations of the epithelial basement
membrane (EBM), and undulations of Bowman's layer. Findings in or
adjacent to the wound included collagen lamellar disarray; activated
keratocytes; quiescent keratocytes with small vacuoles; epithelial
ingrowth; eosinophilic deposits; PAS-positive, electron-dense granular
material interspersed with randomly ordered collagen fibrils; increased
spacing between collagen fibrils; and widely spaced banded collagen.
There was no observable correlation between postoperative intervals and
the severity or type of pathologic change except for the accumulation
the electron-dense granular material. CONCLUSIONS: Permanent pathologic
changes were present in all post-LASIK corneas. These changes were most
prevalent in the lamellar interface wound. These changes along with
other pathologic alterations in post-LASIK corneas may change the
functionality of the cornea after LASIK.

Glenn - USAEyes.org

2005-07-30, 5:54 pm

Tabby's apparent alarm of "permanent pathologic changes" in LASIK
patients is hyperbole of the highest order. Of course there are
permanent pathologic changes, the eye had surgery and permanent
pathologic changes (to improve uncorrected vision) is the intent of
that surgery.

This reminds me of the morning radio deejays who raised the alarm that
it appeared there was dihydrogen oxide in the city's water supply.
They claimed that some of the toxic properties of dihydrogen oxide are
that it can cause excessive sweating and vomiting, is a major
component of acid rain, can cause severe burns in the gaseous state,
accidental inhalation can kill you, it is a primary contributor to
erosion, it can decrease effectiveness of automobile brakes, has been
found in tumors of terminal cancer patients, and may dissolve metal
ions especially in the presence of road salt

In 1991, 4,100 Americans— many of them under the age of 10— died from
excessive dosages of dihydrogen oxide commonly found in many homes and
recreation sites.

To make matters worse, apparently dihydrogen oxide has made its way
into our food supply. A common peach was found to be 85% dihydrogen
oxide.

Of course, dihydrogen oxide is H2O..water. Everything said about
dihydrogen oxide was true, but very misleading. Tabby is apparently
doing his best to repeat such foolishness.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

serebel

2005-07-30, 10:54 pm

Apparently Tabby's "chicken little" mind is still lacking the
dihydrogen oxide to keep her sane.
She still doesn't get it that the whole point of RS is to change the
pathology of the cornea.

SErebel

Glenn - USAEyes.org

2005-07-31, 8:54 am

But it really does sound frightening doesn't it. At least until you
understand the reality.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Tabby

2005-07-31, 6:01 pm

Wow, Glenn and SErebel are so painfully ignorant. Hyperbole isn't
published in peer-reviewed journals of any quality. What are reported
here in the Emory study are objective data about the ongoing disease
processes and structural damage present in all corneas after LASIK.
Yes, the study I referred to was indeed from Emory university and
published in the journal Cornea. If you knew anything at all about cell
biology or even LASIK you'd be concerned for patients who have had/will
have LASIK. Sadly you don't have the educational background to grasp
the significance of these findings.

SErebel, the point of LASIK is to change the refraction of the cornea,
not the pathology. You just said that the whole point of RS is to make
the cornea diseased. (Pathology is disease). Hey, if that really is the
point, refractive surgeons are doing an EXCELLENT JOB. Well done,
refractive surgeons... millions of sick corneas out there due to your
efforts.

Keep harming people for cash and calling it medicine! It won't be much
longer before your colleagues who really are the healers that you are
not...and patients alike... recognize you for what you are.

Glenn - USAEyes.org

2005-07-31, 6:01 pm

I am not suggesting that anything in the cited article is inaccurate
or blown out of proportion. What I am saying is your opinioned
analysis of the meaning of the article is inaccurate, misleading,
blown out of proportion, and simply wrong.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Tabby

2005-07-31, 6:01 pm

Glenn - USAEyes.org wrote:
> I am not suggesting that anything in the cited article is inaccurate
> or blown out of proportion. What I am saying is your opinioned
> analysis of the meaning of the article is inaccurate, misleading,
> blown out of proportion, and simply wrong.
>
> Glenn Hagele
> Executive Director
> USAEyes.org
>
> "Consider and Choose With Confidence"
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.

Most of what I posted was actual content from the articles (which were
cited properly). What I actually said (my so-called opinionated
analysis) is in quotes.

"Avoiding surgical procedures on the cornea would be a good start
toward preventing this catastrophic chain of events!"

OBVIOUSLY, IF YOU DON'T HAVE REFRACTIVE SURGERY, YOU WILL NOT HAVE SICK
KERATOCYTES IN YOUR INTERFACE. BECAUSE YOU WON'T HAVE AN INTERFACE.
DOESN'T THIS MAKE SENSE?

"If you have had LASIK, you have permanent patholotic (disease) changes
in your corneas."

THIS STATEMENT IS FULLY SUPPORTED BY THE REFERENCE BENEATH IT.

"Perhaps neurotrophic keratitis explains the degeneration of
keratocytes in the stroma of 100% of post-LASIKs."

LOSS OF PROPER INNERVATION CAUSES DEGENERATION OF OTHER TISSUE TYPES,
SO THIS IS A PERFECTLY REASONABLE HYPOTHESIS.

Glenn, I don't have to blow anything out of proportion. Real science is
exposing LASIK for the flawed, destructive procedure that it is.

You have blanket (what did I see it referred as here on this BB???)
'Hagele-hokum' responses for every occaision but your pat accusations
and denials seldom apply. They certainly don't here.

Glenn - USAEyes.org

2005-07-31, 10:53 pm

Okay Tabby, since you believe you have all the answers on this issue.
What, exactly are keratocytes? What is their function in the cornea?
What is the consequence of keratocyte degeneration after surgery? Is
keratocyte degeneration during recovery a balance of keratocyte
acceleration after surgery? How, exactly, is a degeneration of
keratocytes in the stroma after surgery a "catastrophic chain of
events"?

Your position that LASIK is "flawed" is inaccurate. It is a reasonably
predictable elective surgical procedure that, like all surgery, is not
perfect. There is no such thing as a perfect surgery. All surgery has
some element of risk. If one is not willing to accept any risk, than
one should not have any surgery of any kind.

As to your oft stated position that no one should have LASIK
(apparently because you did not get what you wanted); yes, anyone who
avoids surgery will avoid any possible consequence of that surgery.
Equally, they will avoid any possible benefit.

There are hundreds of thousands of cases each year where intelligent
and informed individuals make the decision to accept the potential
risk for the potential benefit. That is an individual decision based
upon the unique circumstances of each person and should consider the
information provided by a competent surgeon after a complete
examination.

LASIK is not for everybody, but then again, it is not for nobody
either.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

serebel

2005-07-31, 10:53 pm

Tabby wrote:
> Wow, Glenn and SErebel are so painfully ignorant. >

Painfully ignorant ? Don't you know that ignorance is bliss ? You must
be very happy.

> SErebel, the point of LASIK is to change the refraction of the cornea,
> not the pathology. You just said that the whole point of RS is to make
> the cornea diseased. (Pathology is disease).

Pathology is not disease. It is the study of the progression of a
disease.

Since you are such a genius, why did you have lasik ?

SErebel

2005-07-31, 10:53 pm

In article <1122844080.895359.27820@f14g2000cwb.googlegroups.com>,
"Tabby" <tabby_english@yahoo.com> wrote:

> "If you have had LASIK, you have permanent patholotic (disease) changes
> in your corneas."

Tabby

this is where your interpretation of the study goes wrong. Pathology
does not only mean disease. In many cases it does. But it also refers
to any change from the norm. Indeed, LASIK eyes have pathologic
changes--that's the purpose of the surgery. To change the cornea in
order for the person to see more clearly. It doesn't mean it induces
disease.

From Merriam-Webster Medical Dictionary 2002
pathology

n 1: the branch of medical science that studies the causes and nature
and effects of diseases 2: any deviation from a healthy or normal
condition

No one will argue that the cornea post-LASIK has not been changed. And
the study doesn't conclude that these changes have any effect on the
function of the cornea (it "may"):

CONCLUSIONS: Permanent pathologic changes were present in all post-LASIK
corneas. These changes were most prevalent in the lamellar interface
wound. These changes along with other pathologic alterations in
post-LASIK corneas MAY change the functionality of the cornea after
LASIK.

Why make such a broad conclusion as all LASIKed eyes are diseased when
clearly that is not the conclusion of this study. All LASIK eyes have
pathologic changes. If mine didn't, I'd want my money back. I wouldn't
be able to see a thing without corrective lenses!

I'm not arguing at all that there are no changes to a post-LASIk eye.
But this study does NOT conclude that those changes have any negative
effects at all. That's not to say that other complications can happen
as a result of LASIK, but this study's conclusion is inconclusive with
regards to any changes to corneal function. They simply don't know;
their subjects were cadavers and couldn't see or say anything about
their quality of vision at the time, LASIKed or not. What they did know
was "In patients for whom visual acuity was known, the first
postoperative day uncorrected visual acuity was 20/15 to 20/30. In
patients for whom clinical records were available, the postoperative
corneal topography was normal."

BTW: "patholotic" is not a word

--
~RT