Post buttonhole VA improvement

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Post buttonhole VA improvement

Postby M3IT » Sun Jul 08, 2007 9:04 am

Hi all,

I had LASIK around 12 months ago on both eyes (both ~ -3.0D pre op). One eye went OK, but the other had a buttonhole flap complication and the therefore the ablation wasn’t performed.

Post op, the “good” eye ended up +0.9D (over-corrected) and I needed a contact lens until a retreatment was performed some months later. Previously I couldn't wear contacts, but fortunately, after trying 5 different brands, I was able to find some that I could tolerate (Oasys). Post retreatment, this eye achieved equivalent VA to BCVA pre-op (20/15), although this has since dropped to 20/18. So I’d have to say that at this stage I’m very happy with this eye.

With the other eye (that had the buttonhole), things have been interesting. At first vision was close to pre-op, but with blurring where the buttonhole was. However, after a few months the vision started to IMPROVE, and has CONTINUED to do so since. The surgeon didn’t want to re-operate until the eye was stable, but things have kept getting better. I’ve been wearing a contact, but the strength of it has reduced every few months. I’m now at the stage where I can get by without the contact (it’s a little annoying, but less annoying than the contact). However, while my UCVA has improved greatly, my BCVA has hardly changed (has remained slightly worse than pre-op).

The change has now stabilised enough that the surgeon feels ready to have another go at this eye. I’m wanting to proceed, but not sure if I should, so I thought this forum was an ideal place to ask some questions:

1. Has anyone here ever heard of UCVA changing post buttonhole with no ablation (in this case from -3.0D to -1.0D (-0.5D cyclo))?
2. I don’t feel that the UCVA will change much more (has only changed 0.5D in 2 months), and that I will always have some vision impairment due to the buttonhole interface. The surgeon is recommending PRK to remove this. I’m seeking comments on the validity of this.

Any advice anyone can offer will be appreciated.

Matt
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Re: Post buttonhole VA improvement

Postby LasikExpert » Mon Jul 30, 2007 11:39 pm

M3IT wrote:1. Has anyone here ever heard of UCVA changing post buttonhole with no ablation (in this case from -3.0D to -1.0D (-0.5D cyclo))?

It would appear that the wound response from the buttonhole flap cause a hyperopic (farsighted, longsighted) shift and thereby reduced your myopia (nearsighted, shortsighted) vision. A change in refractive error due to a corneal wound response is relatively common, but such a change after a buttonhole flap is much rarer.

To verify that this change is due to permanent changes at the deeper stromal layer of the cornea and not more temporary changes at the outer epithelial layer, your surgeon may recommend an ultrasonic scan that would take a cross-section image of the cornea across the buttonhole area. This would show if the change is due to thinning of the epithelium in the center, thickening of the epithelium at the periphery, or actual change in the lower stromal layers of the cornea.

Where the change ocurred will help determine the predictablility of enhancement surgery.

M3IT wrote:2. I don’t feel that the UCVA will change much more (has only changed 0.5D in 2 months), and that I will always have some vision impairment due to the buttonhole interface. The surgeon is recommending PRK to remove this. I’m seeking comments on the validity of this.

PRK seems to be a reasonable and wise recommendation if you are otherwise an appropriate candidate. The PRK process will laser through at least some the buttonhole flap and can reduce the scaring that is causing a degradation of your vision.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
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Postby M3IT » Wed Aug 01, 2007 3:07 am

Thanks for the input Glenn
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