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Re-float flap with steroid? - 8 weeks post lasik

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  • Re-float flap with steroid? - 8 weeks post lasik

    Right now I am 6 weeks post lasik and had a wrinkled flap in right eye immediately after surgery, which was re-floated at 1 day post op and my vision is still pretty lousy and lots of pain/discomfort still. I'll be going back to surgeon for yet another exam and another corneal mapping in 2 weeks (so 8 weeks along at that point).

    At that point, the dr. is proposing, unless I'm better which seems highly unlikely, that they may want to re-float my lasik flap again in the right eye and irrigate with steroids underneath the flap. The theory being that if my ongoing problems (poor vision quality, pain and discomfort - will explain more below) if it all has to do with slow healing and inflammation at the deepest layer of the cornea that they cannot see with the slit lamp, then the idea is that putting the steroid directly under the flap will finally resolve that inflammation. Doc says they have had a few other patients see immediate results of clear vision after doing this.

    But first, they said they would like me to go back on Lotemax twice a day for two more weeks (I've been off it for a week and things have gotten worse again, though not sure if it's dropping the steroid or allergies making things worse).

    Then when I go back in 2 weeks, before doing the flap re-float, they said they can numb my eye and put on a hard contact lens on it and test my vision with that on to determine whether the re-float with steroid will actually work. The way they explained it, the hard contact lens would temporarily reshape my cornea the way it would be if it didn't have inflammation deep down. If my vision clears with that, then it should clear w/the steroid?

    Does this make any sense?

    Would going on a stronger steroid with more frequent dosing not be an option instead of putting steroid under flap? Or does topical steroid not penetrate that deep into the cornea? (I thought of this question after I left clinic today - wish I had asked it.)

    I found out they do offer aberrometry, though I'd have to travel to another city where there other surgery center is b/c they don't have the machine at the clinic in my town. I'm willing to do this of course, but they seem to think it's better to do this re-floating thing before aberrometry. Will the aberrometry not be conclusive if I have inflammation?

    I'm so confused by all this and terrified of causing more problems. After what I've already been through touching the flap at all scares the hell out of me!

    Oh also should mention I'm on Restasis (only about 3 weeks in so probably not doing much yet) and using artificial tears. Was on Lotemax for about a month and tapered off. Been off it for one week.

    I do have some dryness still, but at this point everyone (surgeon, another corneal specialist, optometrist) seems to agree that dry eye isn't the main cause of my poor vision quality b/c my dryness is not severe.

    My vision in the right eye still fluctuates a lot. On the WORST days, it can be completely hazy all over and blurry to the point that I can't read a license plate on the car in front of me (with both eyes open I can, just not with right eye). Sometimes there is also doubling/ghosting, but not always, and the night halo thing is still about as bad as day 1 (while left eye it has almost gone away completely). On the BEST days, things don't look crisp and have fuzzy edges and contrast is poor.

    The weird thing that near vision in right eye is clear. It's just when something is more than a few feet away that the vision gets bad. Except when the haziness comes back, that's all over, but it's very light haze.

    What the docs all say is that everything looks perfect clinically - cornea totally clear, vision 20/20 (in right bad eye) and 20/15 in left eye. Today I measured with slight astigmatism (.5) in right eye, which I had no astigmatism a few weeks ago (which I also don't understand - can it still be changing?), but anyway during my exam they checked and the vision did not correct with refraction, so they are now saying (which I figured out from this site a few weeks ago) that something sub-clinical is causing me to have poor vision quality. Thankfully they are no longer telling me "it's normal" over and over again!

    Anyway, I'd love to know what others think of this flap re-floating proposal. Maybe it is a good idea. I'm just worried about it!

  • #2
    Okay, now I'm totally freaking out. Last night my optometrist and the surgeon talked and this introduced a whole lot more confusion.

    Optometrist says surgeon told him we should definitely do the flap refloat and that he hasn't decided whether to irrigate with saline or steroid fluid, depends on what he sees when he lifts flap. He thinks I may have "a thin layer of cells underneath the flap."

    First I've heard of that! Everyone up until now keeps saying it's clear and no signs of cell growth under flap.

    We already refloated w/irrigation on day 1 so what would be the point of that b/c it obviously didn't help?! The steroid theory made sense to me; simply lifting and irrigating w/saline does not makes sense to me.

    My "haze" fluctuates. Maybe haze isn't the right word b/c that seems to be something they keep fixating on and I don't think it's the biggest problem since it's not constant. If the haze was due to "thin layer of cells" wouldn't it be present all the time? And wouldn't I also see it on close-up vision, not just far vision? Besides, if any of this had to do with cell growth under the flap it wouldn't have been present since day 1 right? I've had this poor vision quality since less than 1 hour after surgery.

    What I'm really complaining about is blurriness, fuzziness, doubling/ghosting and what I perceive as poor contrast (though they haven't acknowledged that complaint much).

    I feel like the docs are largely just hearing what they want to hear and gravitating toward the "easy" answer.

    He also now is saying that aberrometry would be the "last option" but I don't understand why. Wouldn't we want to gather all the info we can before proceeding with lifting the flap again?

    Doesn't lifting the flap take me back to square 1 with healing? Obviously some healing has occurred and I hate to think of starting over or even making things much worse, which I know is possible from all the stories here.

    I've had no luck so far finding another doc to see locally and also cannot spend thousands of dollars again on my eyes right now. But I also cannot live like this forever.

    All of this came about in the past 36 hours b/c I was simply calling, as instructed, to let them know how I was doing after being off the steroids for several days.

    I do not feel like I have enough information to make a good decision and have huge doubts about this because it's just not seeming logical to me on the most basic level, yet they seem so sure of it.

    I think I'm going to have a total breakdown.


    • #3
      Nobody has answered and I'm desperate to get some input. Please does anyone have any thoughts on this?

      Best I can gather after a few days of reading online is that they are kind of following the treatment protocol for DLK. But they haven't told me that nor have they said they see any visible sign of inflammation under flap or any debris on examination - they just keep saying cornea is perfectly clear.

      And I read that usually they don't lift flap until stage 3 DLK, but they are proposing the flap lift/refloat. (And what's the difference between lifting and refloating anyway?) Is it possible to have DLK progress to stage 3 without the doc seeing anything through the slit lamp?

      Why aren't they trying me on heavier/more frequent or oral steroids before doing the flap lift? I have a 2nd opinion with another optometrist tomorrow and will be asking all of this, but who knows if he will really be willing to contradict the surgeon.


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