RCE after surface ablation (PRK, LASEK, Epi-LASIK, transepithelial PRK)

[EyesOpen]

you can use ointment as many drs recommend so - just add lid hygiene is the point.

Please explain, thank you.

[MGD1701]

you can use ointment as many drs recommend so - just add lid hygiene is the point.

[EyesOpen]

By the way, the eye with RCE is also my bad eye which justifies ointment blocks glands
- just recently one member (suffers from RCE) in the forum mentioned
her/his NEW dr reommend lid hygiene to avoid blocking glands.

The only ointment I am using now--after reading that ointments can block glands--is the Muro 128. I may discontinue if I find a Dry-Eye doc that says to do so; otherwise, I continue to read that it can help with erosions with long-term use.

[MGD1701]

By the way, the eye with RCE is also my bad eye which justifies ointment blocks glands
- just recently one member (suffers from RCE) in the forum mentioned
her/his NEW dr reommend lid hygiene to avoid blocking glands.

[EyesOpen]

"Based on bad experience, I believe if right treatment, RCE is not that difficult to deal with but none of my +8 doctors told me lid hygiene but ointment which block glands." MGD1701

This is what I've begun to open my mind to--might exacerbated dry eye cause RCE to return? I'm finding that I can alleviate most erosions by wearing a pressure patch. So maybe what I need to do is focus on managing my dry eye so that it is not as severe, and then reassess (I don't want to have to wear a patch for the rest of my life)?

When it became apparent that RCE was happening, panic emotions set in and knee-jerk reaction is to do whatever I can to fix this now. And I'm finding that doctors often react to their patient's emotions to get this fixed! I'm thankful for their compassion; however, it seems if doctor won't bring in some long-term perspective, patient must consider long range.

Thanks for your input, MGD1701.

[MGD1701]

I had RC Erosion for years and PTK took care of it - later one dr told me PTK can make dry eye worse - but I had no choice.
Also have read (untreated) dry eyes can cause RCE - I believe so too.

Based on bad experience, I believe if right treatment, RCE is not that difficult to deal with but none of my +8 doctors told me lid hygiene but ointment which block glands.

Serum drop is good for RCErosion, I have read - none of my +8 dotors knew this.

You better find a real expert. Good luck!

[EyesOpen]

"In PTK, some or all of it is removed. It depends what they're using it for. Here's an example of an abstract where they were comparing PTK and diamond burr polishing as a treatment for RCE/ABMD. They removed 5um (of a total 8-12um typical Bowman's thickness)." Rebecca

Hello, this is my second post, and I came to this forum from a Google search. I see the years on this older thread, but here I am, wanting direction, so I'm asking! My Google search words included "how likely a PTK (or even SK) would really eliminate my RCES." I have dry eye, EBMD and Fuch's (1+ on scale of 4).
I had very little vision problems most of my life, just presbyopia. 6 months ago, however, I had a Peripheral Iridotomy with a YAG Laser, due to having narrow-angle, pre-glaucoma. I had begun having intermittent angle closures (the PI was in hopes it would open the grade enough).

So my question posed is: Is removing 5um of BL standard procedure, and is that amount what you believe causes further issues? I have been to 2 corneal specialists, one wanting to do the SK and the second wanting to do PTK, to alleviate the RCES in this right eye. It is just 120 days out from my cataract surgery. My epithelial is "fluffy" from erosions. I welcome thoughts on whether to give my epithelial some more time before any more laser work. (And there's the "second cataract" that I'll want to deal with some time!)

My optometrist diagnosed EBMD just before my cataract surgeries (cataracts were moderate, but narrow angle was the reason to replace the lenses). What seemed to be little addressed by my specialist or optometrist until my RCES began in my right eye (about 1 month after my right eye surgery) is the Very Important Dry Eye! My understanding is that EBMD with dry eye can (but not always) cause RCES.

Thank you...

[lynnwiggers]

I have just had another erosion this July after having had PTK in December. The entire cornea of the affected eye was treated. I think it was -2.25 before and -2.5 after, I think it was Excimer (sp?) per my husband the epi was removed with alcohol and a swab. I don't know what MMC was. What I can tell you is that the only thing worse than having an erosion is the depression of having them start over after having gone through the surgery. I went through it for 10 months constantly before having Laser surgery and it was like a nightmare, but I thought it was over. 60 days to get back in to see a Corneal Specialist. Oh joy.

[Mcgoldilocks]

Just to add my experience to this thread, a year ago I saw a doctor who examined my eyes thoroughly and said I was fine to go ahead in having laser eye surgery. I did tell him I have had eye pain upon waking several times over the years, and one bad corneal abrasion but he didn't seem to think that was a problem.

I've definitely got ABMD so it's a very good thing I didn't go ahead with it.

[MyDryEyes]

Ian and Liz,

Thank you for the reassurances!! I hope that your RCE's diminish to nothing!! It must be incredibly painful.

MDE

[liz56]

Ian makes a great point. RCE's don't happen to everyone who has these procedures. I keep hearing from various doctors about an "enzyme," and when my second ophthalmologist told me about it, he said that I was lacking it. When I read about RCE's on line, it seemed to suggest that I may have an errant kind of enzyme. I never really did sort that out or understand it.

Also, it is interesting to note that people who suffer from RCE's often note significant improvement after having PRK or PTK. So, go figure! Maybe it is like fighting fire with fire? I don't know, but every case is individual, and it is hard to know what is really happening there in those thin, specialized cell layers that interact so significantly with lipids, saline, and water in the tear film!

--Liz

MDE

I wouldn't worry yourself too much about this.

The fact that you had your cornea lasered is in fact removing tissue.

I initially had a similar reaction to you but then put it in perspective.

As far as the RCE's go, my GUESS is that if you haven't had them by now than it is unlikely that you will develop this condition as a result of your surgery.

Normally RCE's occur soon after surgery as the epithelium is trying to reattach itself to the underlying cornea.

Don't worry too much about this, you probably already have enough to deal with and the reality is you can't do a lot about it now.

Ian.

[MyDryEyes]

Okay, so I am feeling a bit freaked out by this thread. I am about 10 months out from PRK. I haven't had any problems with RCE's - is this a problem that I could still develop??

Also, I find it incredibly freaky that there is an entire layer of the cornea that doesn't grow back. YIKES!!

Diameter of your treatment zone? NOt sure
- Your prescription before surgery? -11.75 left eye, -12 right eye
- What laser was used? not sure
- Method of removing the epithelium? (Scrape... separate... laser...) scrape I do believe.
- Was MMC used? not sure

[indrep]

I think Rebecca is refering to Mitomycin C with the MMC abreviation.

- Diameter of your treatment zone?
- Your prescription before surgery?
- What laser was used?
- Method of removing the epithelium? (Scrape... separate... laser...)
- Was MMC used?

Rebecca

I feel so inferior reading this post as I simply don't know the answers to these questions.

I thought I was well up on my procedure and understood it but the reality is I have no idea what the treatment zone is,
My prescription prior to treatment was L-2.5 and r -2.0 with mild astigmatism
I have no idea what brand the laser way
My epithelium was loosened with alcohol solution and then pushed aside with some round instrument (put in place before the alcohol solution was put on).
Don't know what MMC is.

Your post has prompted me to seek this information from my clinic and I will post when I receive it.

Ian