Laser Eye Surgery/Laskik Complicationn

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Question
QUESTION: Hi there and how are you.
I recently had Lasik on August 12, 2014. A week later I started experiencing hazy vision as if you are trying to see through a clear shower curtain. My doctor who did the surgery on me told me that it was just me having dry eyes and sent me back to work(offshore). But my first day was so dangerous that my job sent me home. I revisited my doctor throwing me on different medications like Predforte, Lotemax, artificial tears such as Refresh Advanced,  Refresh pm, Systane balance,  and Systane Gel. Still no luck. Then he mentioned that it could be DLK. I really didn't know what that was until he explained it and told me to go home to research it myself. My job put me on sick leave until my vision is resolved. For weeks I used my meds, followed by artificial tears, but still my vision dropped from 20/25, 20/30, to 20/40. He sent me to corneal specialist, where I was soon told that I was stage 4 of DLK and that I needed immediate surgery by lifting the flap again to drain the inflammation. My eye doctor did the procedures of lifting my flap last Tuesday (October 14, 2014).  Two visits after the relifting the flap to see if it would make things better,  my vision readings were still in the 20/30~20/40  range.  But his finding of the reasons is that my eyes are still showing that there is dry spots still on the eye. I've done so much to keep them lubricant. I've been miserable for 2 months and a half And could bearly see. I have a follow appointment with the specialist again to geta second option this Friday.

ANSWER: DEAR Cornell Brent

Thank you for your query
I have read about your surgery and subsequent
Complications which you have gone through and
Which has been diagnosed by your corneal sprecialist as
Grade 4 DLK and you have also mentioned that your
Vision has stabilized after relifting of the Corneal Flap
This is to reassure you DLK is a very rare but known
Complication and since you have been diagnosed with
Grade 4 it unfortunately takes quite a few months of vigorous
Treatment but be assured it does tend to settle down over
The period of time i do understand your apprehension regarding
Your visual acuity specially with regards to your job but i would
Again request you to trust n stick to your operating surgeon because
He will be the person best in position to help you completely and work
For betterment of vision have lots and lots of patience which helps healing
And keep visting your operating  surgeon regularly incase any modifications
In eye drops instillation required also you need to to check your eye pressure
Or intraocular pressure incase thats going haywire
And request you to keep me posted with the developments and also
Improvements in your vision

please revert back to me if you have any additional query

Dr Mannu C Rajnani Dr Mannu Laser Eye Surgeries,
1st Floor Society  Plot 433 TPS3 15th Road Khar(West)Mumbai 400052  INDIA  
Tel:Hospital:91-22-26004467-26006801-26007828 / 919664101201
Dr's Mobile:91-9821032072


---------- FOLLOW-UP ----------

QUESTION: Well the Cornea specialist said that my eyes were bone dry and could be a major reason but said that my dlk has cleared quite well from the last time i saw him. He put some type of plugs in my eyes having something to do with tears that escaped my eyes into my nose and back throat.He then told me that it would take at least a week or so to start noticing the plugs full affect.

ANSWER: DEAR Cornell Brent

Thank you for your query
Its excellent news yes now dat plugs have been inserted
Dryness will reduce and also subsequently with more lubrication
Of cornea it will be better in terms of visual acuity but
Please be prepared for longer healing process and have
Tremendous patient and again emphasize to follow up
With same doctor regularly n keep me posted



please revert back to me if you have any additional query

Dr Mannu C Rajnani Dr Mannu Laser Eye Surgeries,
1st Floor Society  Plot 433 TPS3 15th Road Khar(West)Mumbai 400052  INDIA  
Tel:Hospital:91-22-26004467-26006801-26007828 / 919664101201
Dr's Mobile:91-9821032072


---------- FOLLOW-UP ----------

QUESTION: Hello there..it's me again. So far my eyes has gotten really scratchy and dry. As thinking that the plugs would work. The doctor told me that the plugs does not help produce tears but keeps the tears around that my eyes produce, but so far my eyes only produce little amount. Plus the weather has gotten colder:however, drier weather. He recommended a humidifier so I bought a Vick's warm mist humidifier. So far, here is what I am putting in the eyes that was prescribed by my doctor: Predforte, Restasis, Artifical tears, Timolole, and pm ointment at bedtime. Timolole was prescribed, because of the Predforte causing my eye pressure to rise. But the pressure is going down perfectly. Still my eyes are scratchy. I have severe dry eyes. I tried going shopping for artificial tears. Which one is the best recommended in you opionion: Reshesh Optive advanced, Refresh Optive, Refresh Tears, Refresh Plus, Genteal, Blink, soothe etc. It's tough to choose especially with my case. I only been on restasis for two weeks and was told it takes months to kick in.I tried genteal but my eyes are still dry. I also ran across looking at but still debating on TheraTears Nutrition Omega-3 Supplement with Vitamin E, Capsules. Will that be beneficial and if so, will it interfere with the medication I am already prescribed with. I am trying all my best to help my eyes form more tears. Also does my immune system has anything to do with my case and if so, do I need to take immune system vitamins. Please help...my vision has been bad for 3 months now. My vision dropped to 20/40 in left and 20/100 in right eye due to how dry my eyes are. They checked my eye power, seeing that it was still good and found that I am trying to see through the dryness. He said my right eye is more dryer than the other.

Answer
Dear cornell brent

Many thanks for the follow up question

Yes to a certain extent what tablets you have mentioned
May help in yiur case so it will be adviseBle to start those
Also since you have been putting steroidal eye drops which has side effect
Of increasing your intraocular pressure and to counteract that
You using timolo eye drops which is Timolol maleate  some patients
Have been known to have problems with these i personally feel
Yiu can shift to Betaxolol eye drops which may help bettter
Also genteal gel or lacrygel can be instilled few times a day
It has also been noticed with all the eye drops you putting has a
Preservative called benzylalkonium hydrochloride which by itself if instilled
For longer periods can cause issues so if some
Preservative Free eye drops though expensive but will
Help reduce your symptoms

please revert back to me if you have any additional query

Dr Mannu C Rajnani Dr Mannu Laser Eye Surgeries,
1st Floor Society  Plot 433 TPS3 15th Road Khar(West)Mumbai 400052  INDIA  
Tel:Hospital:91-22-26004467-26006801-26007828 / 919664101201  

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Dr Mannu C Rajnani

Expertise

I am a Laser Eye Surgeon specializing in LASIK-Excimer Laser to remove glasses permanently, Phacoemulsification-No stitch surgery to remove Cataract and insertion of Intraocular Lens, Glaucoma, Squint Surgeries, Laser for retina for hypertension and diabetes

Experience

Practicing since more than 27 years now and conducted thousands of surgeries for LASIK (waveguide), Cataract,Phacoemulsification, Glaucoma and Squint in anterior segment of the eye

Organizations
DR MANNU LASER EYE SURGERIES At 1st Floor Saraswati Society Plot 433 TPS3 Khar(West) Bombay 400052 India,Tel: 91-22-26006801-26004467&26007828 Mobile:91-9821032072 Bombay Ophthalmological Association, Maharashtra Ophthalmology Association All India Ophthalmology Association Glaucoma society of India Eye Trauma association of India

Education/Credentials
M.B.B.S, D.O.M.S, , M.S.(Ophthalmology)

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