Severe Corneal Haze

[dducharme]

Hello All,

I had LASEK about 3 months ago now to correct -5 in my left eye and -4 in my right with a slight astigmatism in both eyes. During the surgery 75 microns were removed and MMC was used for 12 seconds in each eye. I'm not sure what laser was used but the surgery was uneventful and I went home.

At the end of week 1 I was 20/40 with both eyes 20/50 in one and 20/40 in the other. By week 2 I was 20/20 in both with 20/35 and 20/30 in the individual eyes. This continued to improve until after 2 months I was 20/20 in both eyes. I also had some light sensitivity and haloing but nothing too bad. It was noted at this week that I was developing a slight haze and I was put on Floroquinilone drops 2x day to clear that up. By the next week my eyes had dropped to 20/70 and 20/60 and were uncorrectable to 20/20 due to corneal haze. At this point I was put on Pred Forte 1 drop 4x day. 2 weeks later my eyes have stopped getting worse but they are still testing at a -2 in each eye.

That being said my surgeon has mentioned that I am only the 4th patient he has seen with this level of hazing in 5 years of performing LASEK. Right now he has me continuing to use the Pred Forte to see if it clears up at all but he is unconvinced that it will clear up with just that. He suggests doing an enhancement to correct -1 in both eyes and seeing if the other -1 goes away with the haze, but if it is just the haze causing this wouldn't that just cause an overcorrection? The other option he mentioned is that he could just remove the epithelium and use more MMC and see if it grows back without the haze. I am slightly concerned about getting more surgery as I managed to dodge dry eyes and haven't needed a single drop of artificial tears but at the same time the State Police recruitment physical test is this December which is the whole reason I got the surgery in the first place.

I see him again in 4 weeks, so I am looking for any suggestions as to what I should do and why. If it is going to clear up from the steroids at what point should I begin to see improvement? How long would it take to heal from removing the epithelium? Also I have noticed that unlike many of the people on the board my haloing is constant not just at night, would that be caused by the haze as well? Thanks for you comments and help as in one week this has gone from the best decision I ever made to the worst and I just hope it swings back to the best.

[LasikExpert]

He suggests doing an enhancement to correct -1 in both eyes and seeing if the other -1 goes away with the haze, but if it is just the haze causing this wouldn't that just cause an overcorrection?

The haze is very likely directly associated with inflammation. The meds are anti-inflammatory steroids, trying to control the inflammation and treat the haze.

The other option he mentioned is that he could just remove the epithelium and use more MMC and see if it grows back without the haze.

MMC is very strong medicine that should be avoided if possible, but used sparingly if necessary. In the diluted amounts commonly used with surface ablation laser vision correction, the MMC has likely done all it can to reduce haze formation. I suggest you seek the second opinion of a corneal specialist before going with a second application of MMC. Also, I suggest that you don't consider a second MMC until after at least 3-6 months of healing.

I am slightly concerned about getting more surgery as I managed to dodge dry eyes and haven't needed a single drop of artificial tears but at the same time the State Police recruitment physical test is this December which is the whole reason I got the surgery in the first place.

Based upon the limited information you have provided, my personal experience with corneal haze, and the experience of patients I know who have had corneal haze, I believe that healing is your primary treatment, not more surgery. Also, much depends upon where the haze is actually located. If it is at the epithelium plane, this is surely going to resolve with healing over the next 4-12 weeks. If it is deeper and at the plane of the stroma it will take longer to resolve, but vision improvement can be expected over the next 4-12 weeks.

If it is going to clear up from the steroids at what point should I begin to see improvement?

The steroids are undoubtedly working now at limiting the hazing and by your four-week exam you should see some changes, although they may seem minor to you.

How long would it take to heal from removing the epithelium?

You could expect "functional fuzzy" vision for 2-5 days with continued improvement for a month with the truly crisp vision returning in 4-6 weeks - IF removal of the epithelium and MMC resolves the haze.

Also I have noticed that unlike many of the people on the board my haloing is constant not just at night, would that be caused by the haze as well?

This indicates that you have true corneal haze, not just an undercorrection. Halo day and night would be expected.

Thanks for you comments and help as in one week this has gone from the best decision I ever made to the worst and I just hope it swings back to the best.

What you need more than anything is time to heal. A friend of mine had extreme corneal haze (like a frosted bathroom window) and after several years the cornea cleared completely. Also, you have a combination of myopia (nearsighted) vision that is probably not corrected with glasses, plus haze. It is often difficult to determine what is haze and what is blurr. If the quality of your vision seems better when you are reading a menu or a book, then the difference is probably due to the myopia. If the quality is the same both near and far, then that is the haze.

[dducharme]

Thanks for your responses. I have been using the steroids now 1 drop 4 times a day as prescribed but if anything I feel that my vision is getting worse not better. It is at all ranges of vision as I cannot read even using a magnifying glass much of the time nor can I see distance. I am wondering if there is anything else I can do to improve my healing time as the surgeon just keeps saying he is not convinced that the steroids are going to work and that I should just go with debridement with reapplication of MMC.

Has any studies shown that taking 1000mg of Vitamin C daily helps after the appearance of haze or does it only help prevent the haze?

Would using 2 drops of the steroids 4 times a day help at all (I noticed this is what is suggested by the manufacturer) or is 1 drop sufficient for this problem?

While doing some reading I came across a paper in the Human Gene Therapy journal titled, "Phase I/II evaluation of safety and efficacy of a matrix-targeted retroviral vector bearing a dominant negative cyclin G1 construct (Md-dnG1) as adjunctive intervention for superficial corneal opacity/corneal scarring." written by Dr. Johnathan C. Song. I was not able to find the full text but as a former microbiologist I am wondering if you know anything about this study and if this has been approved?

Can the hazing be cause or made worse by spending large quantities of time at a computer. I am a Computer Scientist working on my Masters thesis and as such I spend around 8 hours a day at a computer. Right now I have to be practically on top of the computer to read anything even with magnifier on but I want to make sure that is not causing any of the problems and if it is what can I do about it (getting off the computer is not an option)?

I also noticed that when I bow my head down and look through my eyelashes most of the time my vision is clearer. Is this normal? I would do this more often but I find it is very tiring on the eyes.

Finally if I do go with debridement what are the potential side effects and are they more or less prevelent then in LASEK. Specifically I am worried about dry eye as I have managed to dodge that completely this time around, never using a wetting drop even once, and I would like to keep it that way.

Thanks for all the help, I am trying to do everything I can hoping to be back to at least 20/40 by December but I am currently at 20/100 and holding.

[dducharme]

OK, it has been a while so I though I would update my status as well as ask a question.

It has been almost a year since the hazing started and I am still not back to 20/20. In October I decided to go with debridement and had both my eyes done. At this point I am at 20/30 in my left eye and 20/50 in my right eye.

Now for my question, what should I do to improve this? Will time bring these both back to 20/20 or should I do another debridement on my right eye? I really hate contacts and wearing glasses is going to be impossible in the career I plan on going into (law enforcement) so I really need 20/20 in both eyes, but at the same time I don't want to risk more permanent problems when I am currently at a combined 20/30 which is o.k. even if it isn't great.

[theNeckerCube]

I have severe corneal haze and would like to know if your situation improved.

I had LASIK done Oct 2012 and was fine about 3 months post op, since then I've been battling corneal haze.

I feel that the steroid drops are making things WORST not better. Your insight would be appreciated.

[paducahtiger]

I had LASIK 6 mo ago. Was doing fine in right eye until about 3 weeks ago. Got some dust in right eye. I started using drops to clean eyes. Systane. Two weeks ago, got blurred vision in right eye. Dr measured me at 20/70 from 20/20. He told me to layoff the drops since all this started after use. It's been 3 days no drops. Eye seems to have no improvement. Forgot to mention was using drops because of dryness to around the time I got a little dust in eye from installing attic window. I was using the drops 6x a day. I think I just need to wait for about a month. What you all think.

[paducahtiger]

Forgot to mention. I have a little haze.