Still Waiting

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Still Waiting

Postby CherylM » Tue May 08, 2007 11:39 pm

I had customvue lasik March 24th for both eyes. I'd worn bifocals and had really looked forward to no more glasses, except the non-prescription reading glasses - that was fine with me. My left eye has always been quite strong, and the right eye very weak. I can't offer the specifics of visual acuity because I just don't know that part.

During the surgery the surgeon all but said "oops" so I got a little concerned. At the end of the surgery for both eyes he placed medicinal contact lenses on them. He said the cells fell apart - in my reading since then I suppose he was referring to the epithelial cells in the cornea. I asked how frequently that occurs and he just said "it happens."

At the post-op visit the doctor told me I had corneal dystrophy, but that it didn't show up in the testing. I'd never heard of that so was pretty frightened when I looked it up on the internet. Of course the sites I found discussed the most severe cases and outcomes. The doc tells me my case is very light. But I do have questions. The initial conclusion was that the slowness in my healing was due to the CD. Now, however, the doc is suggesting it is more about dry eye conditions.


I've been using Restasis for the last two weeks and was on a special night-time ointment (prescription) until just a few days ago. I'm on Pred Forte 4x a day still and use severe dry eye drops at least hourly. I'm using Gel Teal (sp?) ointment at night.

The left eye seems to have developed abrasions that are stubborn - since this is my strongest eye it is more irritating to me to have the extreme blurriness - someone on this board had described the initial vision after surgery to be like saran wrap over your eyes. I have that, but it's more like seeing through wax paper - though this comes and goes.

I have no choice but to wait it out. The doc says I'll heal and will be very happy with the outcome. I will need enhancement on the right eye and the doc has suggested that perhaps therapeutic PRK is the way to go considering the CD.

I have decided to get a second opinion on the future treatment in particular. I simply don't want a repeat of this problem.

I would appreciate a response to these questions before I see another doctor, though. 1) I assume I would NOT have been a candidate for this surgery had the testing shown the CD? 2) Is the therapeutic PRK (PTK) a viable option if I pursue additional surgery?

I understand from reading other posts it can take weeks or months for complete healing. I just didn't expect to be in that situation, so I guess I'm getting a little impatient.

Any feedback is welcome. Thanks!
CherylM
 
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Re: Still Waiting

Postby LasikExpert » Wed May 09, 2007 1:09 am

.
I believe the first unofficial lesson of medicine is: Never Say Oops.

CherylM wrote:At the post-op visit the doctor told me I had corneal dystrophy...


It sounds like you have Epithelial Basement Membrane Dystrophy (EBMD). You will want to get a clarification from your doctor. EBMD is when the cells at the bottom of the epithelium (outermost soft layer of corneal cells) are less able to attach to the underlying layers of the cornea. EBMD will be exacerbated by dry eyes.

From the Review Of Ophthalmology Handbook of Ocular Disease Management:

"Approximately 10 percent of affected individuals develop transient blurred vision with painful recurrent epithelial erosions. Most patients experience fluctuating visual acuity without discomfort."

CherylM wrote:The doc says I'll heal and will be very happy with the outcome.


That is a reasonable assumption. It all depends on how the epithelium does.

CherylM wrote:I will need enhancement on the right eye and the doc has suggested that perhaps therapeutic PRK is the way to go considering the CD.


This is consistent with EMBD treatment. In more severe cases, the epithelium is removed and allowed to reform over the cornea. Think of this as rebooting your computer. In really stubborn cases the epithelium may be removed and a very light "dusting" of laser energy is applied to the cornea. Think of this as a power-off rebooting of your computer. PRK would seem to be the most likely recommandation by your doctor if you decide to have enhancement surgery.

CherylM wrote:I have decided to get a second opinion on the future treatment in particular. I simply don't want a repeat of this problem.


That is a good idea. You should ask your current doctor for a recommendation of a corneal specialist and no matter who you select for your second opinion, be sure to ask the second doctor to provide a report to the first.

CherylM wrote:1) I assume I would NOT have been a candidate for this surgery had the testing shown the CD?


Even if EBMD had been diagnosed the doctor may have recommended Lasik, however it is more likely the doctor would have recommended PRK to "treat" the EBMD and the refractive error at the same time.

CherylM wrote:2) Is the therapeutic PRK (PTK) a viable option if I pursue additional surgery?


If all other conditions are appropriate, PRK/PTK is a common method to resolve EBMD.

CherylM wrote:I understand from reading other posts it can take weeks or months for complete healing. I just didn't expect to be in that situation, so I guess I'm getting a little impatient.


Recovery time all depends upon how well the epithelium recovers. With EBMD it can become loose again and you have a bit of a roller-coaster ride of vision recovery. Hopefully the EBMD is not severe, or the more aggressive treatment of PRK/PTK will resolve the issue.
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Postby CherylM » Wed May 09, 2007 6:32 pm

Thanks! Your advice is very much appreciated! CherylM
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