Micro folds (microstriae) - UPDATED

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Micro folds (microstriae) - UPDATED

Postby davidmartinomalley » Mon Apr 12, 2010 6:50 pm

I recently had Intralase ("bladeless) Lasik surgery and while my right eye is perfect, my left eye has a ghosting / starburst effect. The vision is pretty good - I'm 20/20 in that eye, but it does tend to blur things a bit. It's a significant annoyance, especially since I work at a computer, but anything that reflects light affects me. Headlights at night are particularly disturbing.

The surgeon diagnosed micro striae (or folds/tenting) on the flap - I'm wondering what others experience has been with this condition. They did get better over the past few days (the day after my surgery was quite bad), but seem to have stabilized since then.

I know it's only been four days, but my surgeon has already raised the prospect of seeing a corneal specialist as an option going forward. This would be quite a burden, as they are located a few hours away - obviously I'd do it if necessary.

Have others found this resolves itself? Is this a part of the healing process? Does it resolve gradually, or will I notice a sudden improvement?

Any advice or stories of similar experiences would be appreciated.

Cheers.
Last edited by davidmartinomalley on Fri Apr 16, 2010 10:20 pm, edited 1 time in total.
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Re: Micro folds (microstriae)

Postby LasikExpert » Mon Apr 12, 2010 7:05 pm

We have a detailed article on Lasik induced microstriae that you may find helpful.

Depending upon severity, Lasik related corneal microstriae tend to be treated by no treatment at all. The internal structure of the Lasik flap tends to relax over time and the epithelium tends to fill in irregularities. In more severe cases the flap may be lifted, repositioned, and smoothed. In very severe cases the flap may be lifted, repositioned, smoothed, and sutured.

A corneal specialist may be appropriate, but this is not just a corneal issue. It is a Lasik flap issue. You want someone who has a significant amount of experience with microstriae, which may be difficult because microstriae that interferes with vision quality is somewhat rare. Discuss with your surgeon if there is a Lasik surgeon with a large number of procedures nearby who may help evaluate the situation.

You are very, very early in the healing process. Microstriae tend to resolve on their own.
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Re: Micro folds (microstriae)

Postby davidmartinomalley » Mon Apr 12, 2010 9:14 pm

Glenn,
Thanks for your response, and for using the word "very" twice! I'll be sure to update this thread with any more information I get, and with my progress in this matter.

Cheers,

David
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Re: Micro folds (microstriae) - UPDATED

Postby davidmartinomalley » Fri Apr 16, 2010 10:45 pm

I just wanted to update anyone reading on my situation and how it unfolded.

So, I was diagnosed with micro striae across my visual zone. I had surgery on Thursday and by Wednesday things hadn't improved enough for my surgeon. She sent me to a trusted colleague who was very experienced with such cases. This surgeon was located 3 hours away, and saw me on short notice. It was a serious move, because of the distance and my personal situation (work, family, etc)

He was very direct in his diagnosis, and recommended immediately fixing the matter. He replaced the flap, and stitched it in a way so that it "stretched" out the striae. He put a "band aid" contact lens on it too.

Within an hour, there was improvement in the striae and Friday morning, when I visited my Doctor to follow up the next morning (today, actually), the striae were gone. I've had the lens removed, and the stitches will stay in place for another week (at least). I have some blurring right now, but I expected that. I still have 20/20 vision, overall.

Still, the difference is amazing. Before, I was "flooded" with light. When I looked at a point source of light I saw what I describe as a "Star of Bethlehem" kind of like what you see on a Christmas card - starting very high, ending low, and very extreme.

I asked my surgeon if I'm "out of the woods", and she pretty much said yes. Barring anything unforeseen, the stitches will come out and the flap will hold.

Lessons learned:

1) We think the problem went back to the first night - at 3am, my left eye was so dry I couldn't open it. The process of opening it manipulated the flap slightly,causing the striae.

2) My doctor moved fairly quickly - inside of a week. In hindsight, she agrees that she could have moved quicker, but I give her credit. She had an experienced colleague who has dealt with difficulties like this, and she sent me to him immediately. She also picked up the cost of treatment.

3) I picked this surgeon because she has a surgical practice, covering lots of services, outside of just LASIK. She had someone that she could refer problem cases to (as was my situation), and I was really pleased to see that her whole practice snapped to attention and dealt with me (I've been into the office 6 times in 7 days).

I firmly believe that if I had gone to just a LASIK specialist, that I would have been kicked to the curb, and the problem would have been explained away - It'll improve with time, or it's just an unfortunate side effect, a risk you deal with, etc.

Of course, I'm not acting like I'm out of the woods yet- I'm still taking this very seriously. It's been a tough week, and i'm really hoping that things work themselves out.

I hope this post helps, I am subscribed, so feel free to comment and/or ask questions.

Cheers.
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Re: Micro folds (microstriae) - UPDATED

Postby LasikExpert » Sat Apr 17, 2010 12:06 am

This is great news, and thanks for the follow-up. Use the thicker preservative-free artificial tears (individual use vials) to keep things moist. You may also want to use a gel lubricant at night. This will reduce any problematic friction.
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Re: Micro folds (microstriae) - UPDATED

Postby ltess » Sat Apr 17, 2010 1:10 am

Is there any way you can have this and see 20/20? I have the terrible ghosting, starbursts, and glare but am told I see 20/20. Could you actual feel anything different in the eye that you had the condition?

Glad to hear you are doing better. Updates are important on sites like these.
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Re: Micro folds (microstriae) - UPDATED

Postby davidmartinomalley » Sat Apr 17, 2010 2:33 am

Yes. I had 20/20 vision in that eye, and that's why my surgeon referred me to her colleague, whom she knew had more experience. I actually think that my best vision can be greater than that, it's just that the 'glare' or 'ghosting' was interfering with my vision.

My left eye felt like something was in it, but I was told that's the dryness. I'm not sure I'd it was that or the flap movement.

Right now it's swollen and sore, but I've just had stitches put in.

What you described is what I felt. However, it was easy for the doctor to see the straie in the slit lamp. She drew a diagram for me and they literally crossed from one side of the flap to the other.

Does that help you? How long have you had this? Did they ever mention striae?
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Re: Micro folds (microstriae) - UPDATED

Postby ltess » Sat Apr 17, 2010 5:52 pm

Thanks for replying. The doctor has checked te flap under the lamp and said it was fine. But I guess thats doesn't mean it does not have striae. My eye does not always feel like something is in it. Like today it feels almost normal but other days, most days it feels like I am blinking over something. I just hate the starbursts, ghosting, and terrible glare.

I had LASIK on March 26th. I am calling the doctor on Monday just to be sure.
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Re: Micro folds (microstriae) - UPDATED

Postby davidmartinomalley » Sat Apr 17, 2010 7:54 pm

Please let me know what the dr. tell you.

I visited my dr. today, because I was a little freaked. She is 95% confident that thus will fix itself when the stitches come out. We know I have great corrective vision, the problem is the flap. She said the flap is very resiliant and can even regrow itself if amputated (that takes a year)

For sure, ask about straie, and update this post.

Cheers
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Re: Micro folds (microstriae) - UPDATED

Postby LasikExpert » Sat Apr 17, 2010 9:47 pm

davidmartinomalley wrote:She said the flap is very resiliant and can even regrow itself if amputated (that takes a year)


That is not quite accurate. The Lasik flap is the Bowman's layer and underlying stromal tissue. These do not regenerate. The outermost epithelial layer does regenerate. If the flap is planar (equal thickness throughout), then it is possible that vision will be okay with amputation and epithelial regrowth, but you would not want to bank on that. Treatment of the existing flap is the best.
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Re: Micro folds (microstriae) - UPDATED

Postby davidmartinomalley » Sat Apr 17, 2010 10:36 pm

Thx Glen. That was just an aside, we're not considering that as an option!

David
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Re: Micro folds (microstriae) - UPDATED

Postby davidmartinomalley » Fri Apr 23, 2010 5:22 pm

I just wanted to give an update on my condition - I had the stitches removed yesterday (Thursday), exactly one week after they were inserted (Actually, I had one removed prior, when it came loose and was thus an infection risk).

Overnight, my vision improved. Although I still have some blurring in my affected (left) eye, it's really not that noticeable unless I cover the unaffected eye. In general, I'm seeing very well - technically, 20/15, but more to the point, the overall visual experience is much better.

My doctor is expecting some more healing, which will hopefully bring the left eye up to par with the right one.

I just wanted to give an update, so that others in the future may reference this, if needs be.

I'm normally a very positive person, but this past two weeks tested me - I'm not sure I passed that test, either! Thankfully I had friends and family to support me, and a job that values peoples health and well being as the top priority.

Most of this week, I had pretty much given up on improvement in the blurring of the left eye, I was compromising on my expectations. That being said, I'm very happy now, and looking forward to a life free of glasses.

I'll stay subscribed to this thread - any questions, please post them here, and I'll do my best to reply.

Cheers.
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Re: Micro folds (microstriae) - UPDATED

Postby LasikExpert » Fri Apr 23, 2010 8:22 pm

Excellent news! Please report back in a month or so to let others reading this thread know the final result.
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Re: Micro folds (microstriae) - UPDATED

Postby davidmartinomalley » Tue Jul 06, 2010 9:41 pm

It's been a little over two months since I posted an update, so, again, I wanted to post a reply so that others in the future who may find themselves in my situation have something to go by.

So my in previous post I was one day removed from having the sutures out - my vision in the left eye was blurry but getting better. The improvements came slowly and gradually. It really was a good two weeks before my vision stabilized in the left (affected) eye.

I likened what I was seeing to an astigmatism effect - if you've ever had an astigmatism and worn contact lenses that didn't account for that, you'll know what I mean.

The vision in the left eye is 20/25, which may well have been what it was corrected to in the first place. Either way, my best attainable is still 20/15 - so, at the 6 month mark, the question is, do I want a touch up?

The truth is, though, that I barely notice it - my 20/15 in the right eye more than makes up for things. I'm not sure I want to introduce the possibility of more complications! I'm quite done with all that, now, thank you very much.

I also had some starburst / sensitivity for a few weeks, but that died down rather quickly.

I still have a little dry eye, but nothing that can't be managed (I had dry eyes before surgery) - I'm very happy with where I am right now. I can exercise, play sports, interact with my children without glasses getting in the way. I only wish I didn't have to take the hard road there.

I hope my experience, and documenting it, can be of some help to others. I'm subscribed to this topic, if there's a way I can help, I will do.

Cheers.
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