Please help - DLK

[faithworks]

Hello,

First of all I would I like to say dat I have gathered a great deal of confidence by reading the questions and answers given by people in general and experts as well.

Well, now my problem. I am a 21 yr old graduate student. I had a -3.00 number in both the eyes. I went thru a LASIK surgery on 20th July, 2007 to remove the numbers i had. I have a small amount of haze under my left eye. My right eye is perfectly fine with perfect vision. My doctor says I have DLK/sands of sahara/epithelial growth watever you may wana call it. I realized there was something wrong after the 3rd day of the surgery. The doctor acknowledged this and lifted the flap and tried to clean it but in vain. After a few days the doctor again examined me. However, he says he does not want to lift the flap again as this might rather increase the haze instead of cleaning it. He said since I have a rather good vision (which is still not perfect), let the DLK remain. He said the DLK will clear itself but will take "months to many months". The problem still persists and this is the 9th week after my surgery. I realize my doctor has handled the situation intelligently, but its so disheartening to know the DLK is still there. Its exact in the line of vision of my left eye. Whenever I try to see with both my eyes I have only slight problem. But when I see with only my left eye, it makes me really sad.

I just want to know whether the DLK will itself clear itself in a few months or should I see another cornea specialist to get the flap lifted and do a surgery ??? Is there any hope of the DLK getting cleared by itself??? Are there any such cases where people have experienced DLK getting cleared by itself ??? Experts and people in general please help me out. Thanks

[faithworks]

can anyone please reply ??? ... i need suggestions plzzz... Mr. Glenn please give a recommendation...

[LasikExpert]

My doctor says I have DLK/sands of sahara/epithelial growth watever you may wana call it.

There is a tremendous difference between Diffuse Lamellar Keratitis (DLK) and epithelial ingrowth. The treatments and prognosis are also very different.

I just want to know whether the DLK will itself clear itself in a few months...

What needs to be established is if you have DLK, epithelial ingrowth, corneal haze, or a combination. DLK is an emergent problem that is treated with steroid drops that halt its progress and normally resolves the issue. Epithelial ingrowth can resolve on its own or require one or multiple flap lift and cleaning. Corneal haze is a part of the cornea's wound response and can resolve on its own or require additional treatment, such as application of Mitomycin C.

...or should I see another cornea specialist to get the flap lifted and do a surgery ???

A second opinion would give you the peace of mind that you are on the right track. Whether or not additional procedures would be recommended depends upon that analysis.

[faithworks]

Hello Glenn,

I confirmed with my doctor and he confirms that I have DLK and not epithelial ingrowth.

So where do I go from here ? I am going to see a corneal specialist very soon. However, just for my knowledge I would like to know whether there are/were any cases of DLK like me? Is there "any" hope of the DLK getting cleared by itself ? I feel it is risky to lift the flap again and getting the problem worsened then getting resolved. Once again I would like to ask: are there indeed any cases of the DLK getting cleared by itself because for me there has been absolutely no change in the vision from the day it has been damaged. Should I really have any hope ???

Please reply. Thanks

[faithworks]

...also i would like to add that i had been using two steroids (hyvisc 0.18%, which my doctor says is just a cleansing agent and prednisolone acetate opthalmic suspension usp, which is an anti-inflammatory steroid) for almost two months. My doctor had asked me to taper it down to zero by now, which i have, so that it does not create more IOP.

I would like to know whether the DLK would(if it does) "automatically" heal itself without using the steroids ???Is there anything that my happen "naturally" to resolve the issue ???... Glenn, please reply. thanks

[faithworks]

Mr. Glenn could you shed some light on this ???

[LasikExpert]

DLK is never static. It is either getting worse or getting better. DLK responds well to steroid eye drops, however emergent DLK does not heal itself. If you are off steroids and your vision is stable, then it is reasonable to assume that you do not have active DLK.

DLK can cause scaring of the corneal tissue. Advanced DLK can cause corneal irregularities, however that does not appear to be your situation. Some DLK scaring can resolve with healing, however your corneal specialist may suggest an application of Mitomycin C to clear hazing that is interfering with your vision.

DLK can reoccur. The symptoms are a rapid reduction in vision clarity and are rather obvious. Treatment is commonly steroids. Difficult cases will require the flap to be lifted, the area cleaned, and the flap repositioned.

[DryEye]

Can DLK occur after an enhancement?

[faithworks]

Glenn: since u say that DLK is never static and my DLK seems inactive to you... does it mean that it is tending towards decreasing itself ? its been almost 3 months now and I have absolutely no difference in my damaged left eye vision... do you think I should be patient and let it heal itself or should I assume that I have a permanent scar ?

[faithworks]

Mr. Glenn plzzzz reply...

[LasikExpert]

DLK can occur after enhancement or original Lasik/All-Laser Lasik.

Faithworks: At 3 months postop the DLK event is undoubtedly resolved. The damage that DLK caused may not be resolved.

It is important to separate corneal haze that is related to the surgery from scaring relating to the DLK. Commonly the DLK scaring will be at the interface between the Lasik flap and the underlying cornea and corneal haze will be deeper in the flap or in the cornea. Your doctor can normally determine this on examination.

A common treatment for corneal haze is Mitomycin C. This is an eye drop applied for a few seconds to the cornea. Mitomycin C seems to work well for most corneal scaring, but can cause changes in the cornea than may change your refractive error. Discuss with your doctor details of your probable outcome if Mitomycin C is recommend.

The prognosis of DLK related corneal scaring is difficult to predict. The cornea does try to resolve scaring, but the location, density, and size of the scaring will determine what treatment, if any, is best. The decision to treat or let heal depends upon the proposed treatment, relative risk, and professional opinion regarding the probability of additional clearing of the scar tissue. This is where your corneal specialist will be of great help.

Remember that all that has happened to you is limited to the cornea, and may be limited to the front part of the cornea. A worst case scenario would be a partial or full corneal transplant. It is not very probable that you would need a transplant, but keep in mind that the worst-case is still reasonably manageable (although certainly not desired).

[faithworks]

Update:

Just had a check-up today(3 months and 5 days) after my LASIK on 20th july,07 and consequent DLK because of the surgery.

The doctor had following things to say:

My damaged left eye has a bad scarring due to the DLK. has some wrinkles and mud-cracks type formations right at the centre of my eye which leads to my diminished vision
Steroids wont help me any further as my inflammation related to DLK is gone
Right now I have a DLK related corneal scarring, 2mm - 3mm in diameter
Relifting the flap and cleaning wont help
Scarring MAY go away, its all upto god now
Has asked me to wait for another 6 months
After which he might ask me to go for PTK to remove the scarring beneath the flap
PTK is a good option since my corneal thickness is 500 microns in the damaged left eye
I will have to be on restasis , since he thinks it mite help for the scarring and also prevent dryness (which is not a problem right now , but just as a precaution)
He has asked me to wear sunglasses to protect further damage from UV rays
He has also asked me to be on good consumption of Vitamin C, which might help the eye to heal
He also advised me against using a lens as he suggests that my mould the cornea shape and if in future we may want to go for PTK it mite create problems

Well a 6 month wait from now seems a lot, but I cant help. My vision in the damaged left eye is 20/20 with correction. I am hoping that the scarring will go away. I have faith in god and hope it should work. To all those suffering from LASIK i pray that your problems get resolved. HAVE FAITH... WILL WORK !!!

Mr. Glenn could you please give a suggestion on my doctors opinion ??? Could you please tell me whether I am on the right track ??? Thanks.

[LasikExpert]

Mr. Glenn could you please give a suggestion on my doctors opinion ??? Could you please tell me whether I am on the right track ??? Thanks.

Everything your doctor has said is consistent with what I know to be current understanding and treatment of DLK scaring. Depending upon exactly where the scaring is located, Phototherapeutic Keratectomy (PTK) may laser away the scared tissue without greatly changing your refractive error. The only thing that didn’t seem to be mentioned was topical Mitomycin C, but whether or not this would be appropriate depends upon the location and type of scaring.

Your epithelium, the outermost layer of corneal cells, will try to reform to resolve the mudcrack effect of the corneal scaring. No prediction on how much success, but you would be amazed at what epithelium can do.

Your brain will start to ignore the bad vision and "look around" the problem area. This is exactly like the blind spot that we all have where the optic nerve enters the eye. We don't "see" the blind spot because the brain has learned to ignore it. This is neural adaptation at its best. Even though there may be no change in the actual haze, your vision can improve.

When something like this happens it is difficult not to have your faith in your doctor (or the procedure) shaken to your bones. To be sure you are on the right track and for some peace of mind, I recommend you seek a second opinion with a corneal specialist. What you have related to us sounds like your doctor is current, but another perspective may be helpful.

Something else to expect: you are going to beat yourself up about this. Expect it. It’s normal. This is elective surgery and now that it has gone the wrong direction it is really, really easy to second guess yourself. It is easy to get depressed about this. Expect it. That’s normal too. These emotional responses will not help your situation, but they are absolutely to be expected when going through something like this. Seek a friend or professional for help if/when it gets too tough. There is no need to go through this alone or without the tools that may help you through the rougher times. You have us here too. We may just be a collection of bits and bytes, but we care too. You will need to put your nom de plume to the test.

You are also going to need to be patient. Several published case studies have shown that it can take 12-18 months for DLK scaring to clear and get the patient back to 20/20.

Please do keep this forum informed as things progress. It is rare that someone reaches Stage 4 DLK these days and many will be very interested in your recovery.

[zhuki]

Hey man , sorry to hear about your problem , but im kinda going through the similar thing myself right now. Its been 8 weeks and my eye still doesnt have the perfect vision although its a little bit better that it used to be , but still i cant read prints like this on the pc with my right eye , but i can read letters on billboards better than with my other cured eye (weird!)
my vision is 20/25 in that eye but whats worying me is that i cant read these letter from a distance (maybe glen could explain me a bit , thatd be helpfull).
And like Glen said, dont loose your hopes mate, wait for the best and it will sure come . I really hope you get cured as fast as possible.

[LasikExpert]

Zhuki: It sounds like one of your eyes is a little myopic (nearsighted, shortsighted), which provides good near vision, and the other eye is plano (no refractive error) or slightly hyperopic (farsighted, longsighted), which is providing good distance vision. An eye prescription would be able to determine if this is the case.