Please help - DLK

[faithworks]

Glenn:
As you mentioned there have been several published cases of people with DLK getting 20/20 after 12-18 months, could you please give me web links of those published cases ? I am really frustrated now. I am losing all the hope. Its been 100 days now and no signs of improvement in my damaged left eye. Does the DLK really go away or are you saying this only to give me hope ??? :( ... i am really sorry, but this is really getting frustratin now. Please reply Glenn.

[LasikExpert]

The scaring can, and commonly does, go away. It is very, very slow and gradual. There are cases of scaring that does not fully resolve, but they are rare.

I recommend you visit PubMed, which is a repository of medical journal articles in the US National Libraries of Medicine. Enter "Diffuse Lamellar Keratitis" in the search and you will get virtually all published information in the US and much of what is published abroad. Remember to look at it chronologically because the most current information is what is most important.

I'm not just trying to make you feel better, although to be honest I would like to if I could. Resolution is not only possible, it is probable. Unfortunately it will likely take a long time. How much you will resolve depends upon many things including how bad is the scaring.

Something proactive you can do that may help and won't hurt (unless you are allergic) is taking vitamin C. 500mg twice a day has been shown to reduce corneal scaring in PRK patients. It has many anti-oxidant advantages.

[zhuki]

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.

thanks for the asnwer, and yeh i think i might have a bit hyperopia in my right eye and my left eye is a bit myopic , even after the surgery but i guess cus i had very high myopia, its still ok tho , ill just wait for some more time and hope for the best.
Also hope all the best to you faithworks aswell.

[faithworks]

Glenn:

As you suggested, I looked upto PubMed and researched for cases with DLK. I found that in many cases DLK was resolved only in the early stages with aggressive topical corticosteroids when DLK was active. However, my case is different. My inflammation is gone and what is left is the consequent scaring caused by the DLK. I read that if the DLK inflammation is not resolved in the intial stages, it leads to "permanent" scaring of the cornea with "visual loss" which cannot be recovered. However, I did find only one single case wherein the DLK realted corneal scaring was cleared albeit 5 years after the onset of the scaring. I did not find any case with DLK related corneal scar getting resolved within 12-18 months. You may ofcoure be more educated and would have come across cases wherein resolutiuon would have been faster, but I did not find any :( ... Is all this info correct ? Please reply Glenn...

[LasikExpert]

Here are two Stage IV DLK that resolved, one sponatneously, and one without stage noted (obviously Stage III DLK) but resolved after 16 months. Yes, the scaring can be permanent, but is not always.

These abstracts include other issues, such as a lost flap, subclinical haze, different meds, etc., but they show that even bad DLK scaring can resolve to where it no longer interferes with vision. That does not mean that you won't need treatment such as PTK or Mitomycin C, but it is a possibility.

~~~~~~~~~~~~~
Journal of Refractive Surgery, 2007 Jun;23(6):625-7.

Repositioning of free cap four days after LASIK.Cheng AC, Wong VW, Rao SK, Lam DS.

Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.

PURPOSE: To report management and outcome of late repositioning of flap dislodgement after LASIK. METHODS: A 27-year-old man underwent LASIK in the right eye for correction of myopia, which was complicated by free cap. The flap was repositioned, but dislodged 2 days later. The dislodged flap was stored in balanced salt solution for 48 hours and repositioned 4 days after initial surgery. RESULTS: Postoperatively, the flap remained apposed, but diffuse lamellar keratitis and epithelial ingrowth developed, which was managed with topical steroids and topical mitomycin C. Stromal haze gradually decreased by 16 months postoperatively, resulting in best spectacle-corrected visual acuity of 20/20. CONCLUSIONS: Flap dislodgement > 48 hours postoperatively can be repositioned with good visual outcome. The flap should be preserved in the event of such complication.


~~~~~~~~~~~~~
Journal of Cataract and Refractive Surgery, 2006 Feb;32(2):353-6.
PubMed

Stage 4 diffuse lamellar keratitis after laser in situ keratomileusis Clinical, topographical, and pachymetry resolution 5 years later.

Michieletto P, Balestrazzi A, Balestrazzi A, Alegente M, Boccassini B.
Ophthalmic Hospital, Rome, Italy.

In March 1999, a 35-year-old woman had uneventful laser in situ keratomileusis in both eyes on the same day. Five days postoperatively, slitlamp biomicroscopy of the left eye showed an appearance similar to haze after photorefractive keratectomy, with greater density at the center and striae convergent toward the infiltrate (stage 4 diffuse lamellar keratitis [DLK]). The patient received treatment with dexamethasone 0.2% eyedrops every 2 hours. After 2 weeks, visual acuity was better and improvement was evident on topography, pachymetry, and slitlamp photography. The improvements were more marked at 6 months and 1 year. There was a progressive increment in corneal thickness and consequent improvement in corneal transparency, curvature, and regularity. This case, in which continuous morphologic adaptation of the cornea occurred, indicates that observation, rather than intervention, is a valid therapeutic option for stage 4 DLK.

~~~~~~~~~~~~~
Journal of Refractive Surgery, 2004 Jul-Aug;20(4):391-6.
PubMed

Confocal microscopy of stage 4 diffuse lamellar keratitis with spontaneous resolution.

De Rojas Silva MV, Díez-Feijóo E, Rodríguez-Ares MT, Sánchez-Salorio M.
Fundación Instituto Galego de Oftalmoloxía, Complexo Hospitalario Universitario de Santiago, University of Santiago, Santiago de Compostela, Spain.

PURPOSE: To report confocal microscopic findings at the onset of stage 4 diffuse lamellar keratitis and after its resolution. Stage 4 is the most severe form of diffuse lamellar keratitis. Its incidence is approximately 1 in 5000 and is associated with stromal melting, deep flap folds, central haze, hyperopic shift, irregular astigmatism, and severe decrease in visual acuity. METHODS: A 22-year-old woman underwent bilateral uncomplicated laser in situ keratomileusis (LASIK) for myopia. Postoperative course in the right eye was uneventful; however, in the left eye, stage 4 diffuse lamellar keratitis developed. Confocal microscopy examination was performed in both eyes at the onset of the syndrome and after its resolution. Findings in the eye with diffuse lamellar keratitis (left eye) were compared with the uninvolved (right) eye. RESULTS: The condition improved spontaneously and 2 years later, slit-lamp microscopy showed resolution of the folds and haze with subsequent improvement of visual acuity. However, confocal microscopic examination in the left eye revealed a persistent stromal subclinical haze on both sides of the lamellar cut and prominent folds that extended into the anterior stroma. CONCLUSION: Confocal microscopy revealed that in spite of normal appearance on slit-lamp microscopy, micromorphological alterations persisted after spontaneous resolution of stage 4 diffuse lamellar keratitis.

[faithworks]

Glenn:

Thanx a lot for all the trouble of researching for me. I really appreciate it. I will just have to keep my fingers crossed now (for a long time thou) and hopefully God will hear my plead and I will get my eye back... Thanx a lot once again for all the help. Your suggestions really backed me up. God bless you !!!
I will keep you updated. Thanx.

[faithworks]

Hey Glenn:

112 days and no improvement on the scar established by DLK. I would like to ask you that if I plan to undergo PTK and application of Mytomicin-C 5 months from now, would my vision get worse ? Could you please brief me on all the specific disadvantages of PTK. I would like to balance on how bad my current status is with how worse it vould be if I undergo PTK. Also, if the enhancement is successful, can I get "perfect" vision that I have in my other undamaged eye ? I ask this because my doctor suggests that I should never expect my damaged left eye to become as clear as my undamaged right eye again in life - even after I undergo surgery. He is a vastly experienced doctor and such a statement by him makes me all the nervous. Please reply Glenn. Thanks. HAVE FAITH... WILL WORK !!!

[LasikExpert]

FaithWorks,

I am attending a medical meeting at the moment and will delay my response until I have more time to answer your concerns fully. I will also contact you via email later this week. A think a phone conversation may be more productive and then we can return to this forum to let people know what is happening.

I also want to put you in touch with a woman who has Lasik in 1999 and went to a full Stage IV DLK with major flap melt. She reports that all haze has resolved (although her flap was badly damaged and that has not been fully resolved). She is very knowledgeable about these issues and you can benefit from her first-hand experience.

[faithworks]

Sure Glenn, I would like to be in touch with you through e-mail or/and phone. My email address is [redacted] I would also like to talk with the lady in concern. Please forward me her details. Thank You.

[LasikExpert]

I have sent the contact information to your email and redacted it from here so you don't get a lot of extra spam.

We will also need to keep this forum up to date on your progress as this will be very helpful for others.

[faithworks]

Hey Glenn, I checked my mail but I still have not received the contact details. Could you please try sending it again ??? Thanks

[faithworks]

Hello Glenn:

I emailed the lady you mentioned and she has not replied yet. Could you please ask her to do so ? Also I had posted some questions some days back and you were busy with the AAO conference. I am posting it again so that people can view them as well:

Hey Glenn:

125 days and no improvement on the scar established by DLK. I would like to ask you that if I plan to undergo PTK and application of Mytomicin-C 5 months from now, would my vision get worse ? Could you please brief me on all the specific disadvantages of PTK. I would like to balance on how bad my current status is with how worse it vould be if I undergo PTK. Also, if the enhancement is successful, can I get "perfect" vision that I have in my other undamaged eye ? I ask this because my doctor suggests that I should never expect my damaged left eye to become as clear as my undamaged right eye again in life - even after I undergo surgery. He is a vastly experienced doctor and such a statement by him makes me all the nervous. Please reply Glenn. Thanks. HAVE FAITH... WILL WORK !!!

Thank you for everything Glenn. Please reply at the earliest. Thanks.

[faithworks]

i need ur reply Glenn :(

[LasikExpert]

I sent the message to v*********@hotmail.com. I re-sent the message. Please verify you got it or give me a call at 800-USA-EYES.

[faithworks]

Hi guys,

An update after a really long time. Six months back I had a visit to my doctor who did not have any high hopes on my DLK.

Six months later... its much much better. The scarring is almost completely gone... just a tinge of hint under the flap but he says it shall go away in the next few months.

I had restasis for 6 months... he says that helped lot... including Vitamin C regularly (one packet of Emergency-C 1000mg) everyday.

The DLK has left a scarring which should also improve with time... not soon but it will with time.

I already have 20/20 in my left eye which had DLK (yay!!!) Right eye was perfect and still is with 20/15.

To clear some leftover haziness I will have a prescibed contact lenses for which I have an appointment scheduled next week. This will even get rid of slight ghosting that I have wid my left eye.

I started having starbursts some 3 months back and they go away in front of a light source. They werent there inititally. But they dont bother as they dont bother much until its completely dark around.

The only thing I would like to say if ppl have LASIK and by chance get a DLK (I pray no one shd go thru this) :

IF YOU HAVE A DLK (a stage 4 version and if it doesnt help with medication) YOU SHOULD DO ONLY ONE THING: DO NOTHING

Patience helps a lot in life and it does in medical cases as well. I wonder had I undergone a relift of the flap and would have worsened my case but I had faith in GOD and yes FAITH WORKS !!!

I will just wait for the lenses next week that should possibly give me a perfect vision in my left eye as well. Also, I pray I get rid of my dry eyes.

If anyone has a question I am ready to answer with my experience. This forum has helped me a lot. I gained a lot of courage. Thanks Mr.Glenn. GOD BLESS YOU. You are one of the best people in life I have met to show such compassion without expecting anything in return. I pray for your wonderful journey in life ahead.

I will check this forum regularly in case I am asked any question.

Thank You,
Faithworks !!!