Liquid in eye during Lasik

[ksgirl]

I just had Lasik done on both eyes last Friday. It's only been four days, but.... During the procedure on my left eye (the second eye), I noticed something strange. In the middle of the surgery, there appeared to be a liquid that came out of my eye. The little pinpoints of red lights suddenly became blurry and looked more like horizontal rays of light across my eye. In a few seconds, the operation was over. Neither the doctor or the attendants mentioned anything. I thought it might be normal. My boyfriend, who had been watching the surgery, asked me later what that was that came out of my left eye during surgery. He said that it appeared all of a sudden and spread quickly across my eye towards the last few seconds of the procedure.

Well, now I'm worried because my left eye is still blurry whereas my right eye has been getting clearer everyday. I can't see clearly at any distance in it. Does anyone have an idea as to what may have happened to me?

I've got an appointment this afternoon with the surgeon's associate. When I told him on the phone what I thought happened, he said that it was probably no big deal. I don't know if this is true. I've never heard of this happening to anyone else. Any thoughts?

[LasikExpert]

The observation of liquid emitting from the eye in the laser treatment area indicates a serious problem could be ahead, however what was seen may not have been what it appears to be. Don't panic yet.

I recommend that you contact your doctor's office and insist that your follow-up appointment be with the surgeon, not an associate. Discuss frankly what was observed and request a diagnosis, prognosis, and treatment plan - in appropriate.

Please report here what you learn and any additional symptoms you encounter. Also, in what city to you reside?

[ksgirl]

I went in yesterday for my follow-up with the associate doctor. He did a quick vision test on me. My right eye seems to be fine and is seeing almost 20/20. The left eye, which is the one that I saw liquid come out of, is only seeing 20/60 and has an astigmatism now. This doctor told me that I need to give it more time to heal, but that everything looks fine so far. He said he wanted to wait a few more weeks to see if the vision improves. If it doesn't, he thinks we'll need to do an "adjustment" on that eye.

I point blank told him that both I and my boyfriend saw liquid come out of my left eye during the surgery. All he would say is that he has never seen that happen before. Since he was not the one doing the surgery, he said that he really couldn't comment on that. If there was liquid in my eye, it shouldn't have affected the laser.

They made another follow-up appointment for me with another of his associates in about 10 days.

Based on your post, I will call and request to see the surgeon that actually did the work.

Other than haloing at night in both eyes and the blurry vision in the left eye, I don't really have any other symptoms.

My biggest concern right now is that if they can't identify what I saw happen, then how can they be sure it won't happen again during the "adjustment".

My surgery was done in Overland Park, Kansas.

[LasikExpert]

A laser is just highly condensed light. Light is affected by liquid. Relative humidity in the laser room can affect the laser. Barometric pressure can affect the laser. A visible fluid buildup on the corneal bed while the laser is operating would most certainly affect the outcome. That said, vision of 20/60 in that eye is not very bad and could be attributed to more common post-operative difficulties. The fluid may not be involved at all.

When, precisely, during the surgery was the fluid visible? Was it after the Lasik flap had been created and the laser was operating? I assume that the surgery was recorded. Ask for a copy.

[ksgirl]

It was after the flap was pulled back and towards the end of the laser procedure.

I asked the associate yesterday if the procedure was taped. He just ignored the question. I said I would like to have the surgeon review the procedure if it was taped, because according to my boyfriend who was watching the monitor, it was very noticeable. He didn't answer that one either.

[ksgirl]

I was just told that they do not video tape the procedures. I'm still going to try to get an appointment with the surgeon to discuss.

[LasikExpert]

I suspect your anxiety level is through the roof at this point, so let's talk about the worst case scenario. Once you know the worst, you may not be quite as worried.

Based upon the limited and obviously incomplete information you have provided thus far, and in an attempt to give you an idea of what can be the worst that this could likely be, read on.

The first part of Lasik is to create the Lasik flap. Normally, the flap is about 100-180 microns thick. A human hair is about 60 microns thick. The second part of Lasik is reshaping the cornea by removal of tissue with a laser. As a (very) general rule, about 12-18 microns of tissue is ablated (removed) to correct each 1.00 diopter of refractive error. If your prescription before surgery was -5.00, then about 90 microns of tissue would be removed (5x18=90). Adding the thickest normal Lasik flap to the thickest normal ablation for someone needing 5.00 diopters of correction means that about 270 microns of tissue would be disrupted. Let me point out that the low side of this is 160 microns, but we will use the higher 270 number.

If you need 250 microns to keep the cornea stable and 270 microns would be disrupted during Lasik, then your cornea needs to be at least 520 microns thick before surgery (250+270=520). Leaving more cornea untouched is almost always better. Doctors normally will measure the thickness of the cornea before surgery and do these same calculations with the advantage of more exacting numbers. We are just using the higher side of round numbers.

The device used to make the Lasik flap is called a microkeratome. Although today's microkeratomes are very accurate in the thickness of flaps they create, on very rare occasions the microkeratome may create a flap too thick by cutting too deep into the cornea. Unless the surgeon re-measures the cornea thickness after the flap has been created, this deeper flap may not be noticed. When the laser starts to ablate the tissue, it may ablate too close to the back of the cornea.

The cornea is relatively porous. Nourishing fluids travel from the back (inside) toward the front and oxygen travels from the front (outside) toward the back. If the cornea was ablated deep enough, fluid may present itself.

So, let's assume that this is the worst case scenario for you. That would mean you may have an unstable cornea. If the cornea is completely unstable, you could need a corneal transplant. While a transplant is nothing anyone wants to have, thousands are done successfully every year.

There is nothing in what you have described that indicates you would lose your sight, or that the poor sight you have now would be permanent. You may need additional treatment and it may even be rather invasive, but Lasik only changes the cornea. Everything behind the cornea is likely untouched by this malady you are experiencing and is fine.

So, there is your worst case scenario - a corneal transplant. Even though this is a possibility, it does not seem to me from what we know so far that it is a very high probability.

The question of the fluid needs to be answered, but I advise you to not totally freak out while that answer is coming. Your current vision may be due to one of the many other much more common difficulties that can occur after Lasik and may be resolved with something as simple as enhancement surgery. I personally know how hard it is to keep the faith when you cant' see out of one eye, but anxiety will not do you any good and may cause you to make poor decisions. Just move with deliberation toward diagnosis, prognosis, and a treatment plan. I'd be delighted if we can discuss each of the steps you take so others who may have similar symptoms may learn.

[ksgirl]

Thank you for your time in writing that very helpful reply.

My eyes needed 9.0 diopters of correction. I remembered that he measured my cornea thickness beforehand. I asked the doctor if it was possible that I didn't have enough cornea, and if that could have been the reason why fluid appeared. He assured me that I had plenty of cornea left. I still have not had anyone in that office believe that I had fluid in my eye during the surgery. That is the most frustrating part. They just aren't taking my concern seriously. Therefore, I still don't have a diagnosis.

[LasikExpert]

If your cornea was ablated so thin that liquid came up from the bottom, then your cornea would undoubtedly be completely unstable and your vision would likely be getting worse by the hour. Also, it would be immediately noticeable to the surgeon. The liquid in the eye is a concern, but let's set that whole issue aside and look just at your current symptoms. It may be that this liquid question will never be answered, but if your vision is clear and stable, that's not such a big concern.

You had very high myopia (nearsighted) vision before Lasik. It is common for this much correction to regress back toward the original refractive error during the healing period. Read about Lasik regression. For this reason, surgeons will sometimes deliberately overcorrect to deal with the reasonably expected regression. See deliberate Lasik overcorrection.

Your high myopia is challenging to correct and enhancement surgery to "fine tune" the correction is reasonably expected. Residual or induced astigmatism would also be reasonably expected to need fine tuning. Your current refractive error would indicate if you are over or under corrected and would indicate the amount of astigmatism.

Except for the liquid issue, the vision limitation you describe seems reasonable for someone who started with 9.00 diopters of myopia and a bit more than a week postop. Additional fluctuation in vision quality over the next several weeks should be expected. Read about high Lasik correction.

The doctor and staff may not seem to take your concerns seriously because they are seeing what - so far - is a normal result for someone who started with 9.00 diopters of myopia.

[Sam13]

HI everyone...
Thanks for the good conversation you had both;;;
I really appreciated it,,I have also same problem with you and thank laser experts...