Introduction - PTK Vs. Anterior Stromal Puncture - Feedback greatly appreciated

[MannyP]

Hello all,

I very grateful to be here.

My story - I'm currently struggling to decide my next course of action.

To cut a long story short. I suffered from large erosion back in June 2016 after having LASEK in Mar 2016 (famous high street brand). The erosion cost me two weeks of work. After undergoing a protocol of lubrications and compresses I did not have any further erosions, but have suffered from the dryness sensations (burning, grittiness, soreness) and found it very difficult to work. Seeking a second opinion the conclusion was blepharitis causing an inadequate lipid layer (TBUT 6 seconds and Schirmers 24). Going back to my original surgeon, he dismissed the dry eye issues and performed a test to see if my epithelium was loose (cotton bud touching the epithelium to see if it heaps). My eyes tested positive for RCE according to him and I needed PTK. He believed I was not experiencing dryness, moreover a dryness sensation from a loose epithelium touching the nerves.

I did see an independent Professor and he advised against PTK and dismissed the loose epithelium test. He suggested antibiotics and omega 3. I decided to take this route as I was not keen on undergoing another surgical procedure at the time.

Fast forward to last week – May 6^th 2017 I had another corneal erosion and the Professor is now agreeing I have recurrent corneal erosions, but advised on having Anterior Stromal Puncture immediately.

Conflicting views between surgeons has left me very confused and desperate.

My key challenges are:

• Deciding PTK vs. Anterior Stromal Puncture
• Starting a new job next June (my last company was very lenient and flexible). I work in corporate finance so I'll be on the screen all day and I fear the dryness will impact my ability to earn and support my family
• New born baby - Just had my second child and I cannot help with any of the late feeding in fear that my eyes will suffer too much from lack of sleep. It's hard to watch my wife do it all.

I am reaching out to the Dry Eye Community to see if there are any of you who have experienced a similar situation as myself, or can share outcomes of such procedures as PTK and Anterior Stromal Puncture. I have concerns that any further surgery may exacerbate my dry eye symptoms even more. I would be really interested to hear back from anyone who has either undergone these procedures or found alternative solutions and therefore avoided surgery altogether.

Many thanks for reading.

[MGD1701]

Hi
I had recurrent corneal erosions (rce) and did PTK laser (2-3 years ago) which was successful.
I think my rce was due to dryness but doctors failed to identify that I had MGD - just told me
to use ointments - which was a big mistake as it blocked glands since none of them told me lid hygiene.

Dr checked my cornea recently and confirmed all ok.
After PTK I still often suffered morning/mid-night sharp/short pain (not erosion)
I suspect due to mis-/over-use of ointments. Now I solved this issue. My way:

let warm water run across closed eyes for about 10 times (for removing bacteria, debris etc)
----this is very critical

then warm compress (Blephasteam/42.5C is effective/safe as it has steam)
then massage, lid scrubs + oil-based drops

+ swimming goggle (when sleep)

Hope it helps.

[MannyP]

Thank you for the swift reply MGD1701. I already do the Blephasteam, compresses, night goggles and Hydramed (night ointment). I will look to incorporate the oil based drops and wash suggestion (10 times one).

Do you have the same level of dryness as to prior the Op? Or has it improved.

Glad the PTK went well. What was your recovery like? Did you need 1 or 2 weeks of work?

I'm still trying to understand where a loose epithelium causes dry eye sensations. It's hard to understand what is the root cause, I know this is a very complex subject with multiple aspects.

Thanks again.

[MGD1701]

Hi
PTK solves erosion problem not the dry eye but erosion will damage conera if untreated.
After PTK, I do not have erosions but sharp/short pain which is due to no treaments of MGD
(no warm compress, massage, lidscrubs, oil based drops etc).
Later, doctors finally detected dry eye but gave me WRONG drops - they failed to identify MGD.

Just checked old note - dr said my cornea ephithelium was not good - without details.

I assume you also do (Blephasteam + massage +) lid scrubs in the morning, these are important, especially if use ointments.

If possible, get 3 opinions from different doctors and do your own research. Good luck!

oil based drop: Systance Balance and Retaine MGD (seems Retain is better, I have read).

Omg 3 - maybe take a blood test for omg 3 and 6 see if you really need omg 3 - this can also prove if that professor is correct??
My recent blood test shows my omg 3 & 6 are almost double than normal. My dr said it is ok.

wash eye - the tip is originally from a MD in this forum. full text see below so you can understand better.
Seems many doctors do not even know this that is why almost all doctors ask us to use ointments.

Quote
Trying to keep "dry eyes" moist during sleep with the thickest or smoothest ointment/gel likely will not help and may worsen the problem.
The underlying cause is generally not due to excess evaporation or inadequate water/aqueous production.
It's the oil secretion along your lids during sleep that leads to the cascade of inflammation that cause dry eye symptoms.
Ointments will block the flow of inflammatory components that must drain through the lacrimal system,
since they won't clear by evaporation like water to any great degree.

Try letting warm water run across your closed eyelids for 2 minutes at night and
scrub the lash line of the closed eyelids for 15-20 seconds with a mild shampoo.
The running warm water removes the dirt, oil residue, and bacteria on your eyelids in addition to warming them. Heating pads just warm the lids.
Unquote

[MannyP]

Thanks MGD1701


To add, I have only had 3 erosion's (one that ended in A&E) and two only last week (both 2/10 in pain factor and damage,compared to the first (over 9 months ago), which was off the scale.

I do feel the oil secretion around the 7 minute mark. However I do not do the routine in the morning. I have a new born and 3 year old and find it difficult to maintain the routine in addition to the
all the drops during the day. If you think it really makes a difference, I'll give it a go. I'm sure people here do a lot more, so I don't intend to sound lazy in any way. My wife also has an autoimmune condition, so I always feel guilty that this is taking over my life and I cannot support her and young family.

I do feel scared with letting go of the night ointments, as mentally I feel they protect me from a vicious tear. I did try castor oil for a while, however got my second erosion whilst doing it, so I switched back to the heavy duty night stuff (Hydramed).

Systane balance did not work for me. I've never heard of EVO tears before (will research).

I'm hopeful the surgery (PTK or Anterior stromal puncture) breaks the vicious cycle of reliance on ointments, which will in turn solves any downstream dry eye issues.

I have seen some improvement with my oil secretion since I started using honey drops (Optimel). It may help your MGD.

Thanks again for your swift reply. I really appreciate the support.

[MGD1701]

Hi
You are right. It is too risky to stop ointments now. I do think it makes a difference if you do eye wash, warm compress, massage etc since you use ointment. If you dont have time, maybe eye wash 15-20 times, then massage a bit (to get ride of ointment residue, bacteria, old oil etc), lid scrubs.

Anterior stromal puncture - I did this first as per insurance policy - as it failed so I could have PTK.
The new dr examined my cornea recently did spot right away that I had PTK but said all ok.

Do you close eye 100% when sleep? some people do not.

Optimel honey drop - thanks! will check.

[MannyP]

I do sleep with my eyes 100% shut.

I am seeing the surgeon tomorrow to discuss all my concerns.

Thanks again for the advice. I did a morning compress this morning and I've had a really good day. The dryness has not been as noticeable, especially as the day progressed

BTW - This site is a god send as it's so useful and supportive.

[MGD1701]

Hi,
Just to add: I did not have Lasik.
My eye with PTK tends to have 'slightly' more problems - watering, discharge - no idea if that relates to PTK.

blepharitis - Dr confirmed I dont have this but I had it very often in the past as no doctors ever told me to do lid scrubs etc.
Sometimes I use tee tree oil shampoo (soap free) to clean eyes especially in the morning.

Oil secretion: I asked you just to make sure you are aware of it as some people do NOT know & it is important.
As to if 7 min. is enough - No idea. Some doctors say the more secretion the better (no idea why?).

Blinking exercise: if you have MGD and frequent computer user, this is important.
I find it very useful and this video is the best by Dr. Laura Pierman
https://www.youtube.com/watch?v=MzeU...Q&spfreload=10