I just got the Prokera procedure done yesterday...

[Phillips55]

I've definitely made progress with my dry eye and other side effects from Lasik over the past year but I still need to improve so I just had the prokera procedure done yesterday. if anyone is familiar with it it's a stem cell contact that you keep in your eye for five days I'll keep this post updated to see how it goes and see if There's any short-term or even permanent benefits to it. My hope is is that it treats the chronic inflammation my eyes have gone through in the past three years since I had Lasik and I'm hoping maybe that there will be some nerve regeneration around the corneal flap. Anyway I'll keep this post updated with my progress for anyone interested. Thanks!

[neilw]

This is very very interesting. Can you please keep us updated on your progress. I would like to know if you are having much immediate improvement and of course how long the improvements will last. Amniotic membrane treatment like this or in the form of AMX could, I believe, be one of our best hopes for an effective and safe treatment for dry eye.

[Rebecca Petris]

Thanks for posting... look forward to hearing how it works out.

[DryLondoner]

How do you know if your nerves haven't regenerated? If your surgeon says "your eyes have healed well" does that refer to the nerves, or just the flap scar?

Sorry if this is a silly question.

[Rebecca Petris]

How do you know if your nerves haven't regenerated? If your surgeon says "your eyes have healed well" does that refer to the nerves, or just the flap scar?

Sorry if this is a silly question.

It's a great question. Common point of confusion. When they say "Your eyes have healed well" they are usually talking about the obvious, visible surface healing. There can be a great deal going on that causes anything from discomfort to worse and yet still be more or less accurately described as having 'healed well'. I "healed well" myself, back in 2001, but I had central islands and dry eye. It's just that the standard slit lamp examination didn't show any of it. They can't see those nerves regrowing in a standard exam - it takes special equipment most doctors don't have.

[Phillips55]

Well I just got the Prokera taken out today. Although its too early to give substantive information, so far so good. Getting it put in and taken out is easy, It's basically a large contact. It may not be large enough for some eyes, I have large eyeballs so the Prokera did move around quite a bit. When it did get out of place I just sterilized my hands and slid it back over the cornea. I've read that they can put a nylon stitch in your eye to keep it in place, that may make things easier. I had mine in for 5 days, and be prepared to do nothing with your eyes for that duration.

Vision through the Prokera is very cloudy, you can only make out shapes that are in close proximity. You can look through your left eye to do necessary things but I got headaches rather quickly. Besides blinking is what moved the Prokera around the most. Other that that I added antibacterial drops in 3 times a day and used otc drops to keep things moist. They recommend taping the eye shut but you'll be peeling that off a lot to put in drops. As far as comfort goes it felt great against the actual eye, it never dried out even overnight. The side against the eyelid is a different matter. There is a circular ridge on the outside of the contact that scrapes against your eyelids with any eye movement or blinking. That's another reason why you should prepare to be immobile for the duration it's in, when I was just laying down with my eyes closed it was quite tolerable.

I will keep posting results and how I feel as time goes by, right now things feel super smooth in my right eye, no discomfort when I blink which has not been the norm since I had lasik. I may go back to that base level of irritation and dryness if the underlying issues weren't helped by the Prokera. I am pretty sure the Prokera did heal the surface of the eye, and at the very least I would be grateful because my corneas have been through hell since Lasik, and because I am not producing normal tears which contains proteins and nourishing elements for the eyes, It's nice to be a device that can get to the cornea and heal it. The real hope that it may have healed or regenerated some of the damaged nerves around the Lasik flap.I really wish I could have gotten con-focal microscopy before and after this procedure to really see what changes, if any, occurred. But it seems no one does this test anywhere close to me which is a shame because I feel it's a very important diagnostic tool. Almost every doctor I've seen likes to dance around the issue, but the bottom line is that for most of us, our eyes worked fine tear wise before Lasik, and were a complete mess after it. I'm not a doctor but the practical answer would be complications from the severed nerves made by the laser. That practical thinking led me to seek out Prokera. If it works well for bad corneal erosions and chemical damage, why couldn't it be used to heal the corneal damage from Lasik? Who knows.

Even if Prokera is not the answer there is more hope on the horizon, Doctors are using people's own limbal corneal cells to actually regrow corneas.
http://time.com/2952812/new-techniqu...an-stem-cells/

I think in the next ten years we will see some real progress for corneal related problems, its important for us to keep everything else in good functioning order. Lasik seems to have a terrible domino effect when it goes wrong, the severed nerves destroys blink reflex and tear production. Lacrimal and Meibomian glands start to atrophy. Problems like mg atrophy seem like much harder problems to solve, so it's and important to keep everything else working properly until the original corneal nerve problem can be remedied. Anyway sorry for the long winded post, Ill keep you folks updated...

[patrick]

Hello phillips,

Thanks so much for sharing. This is extremely interesting.
You hit the nail right on the head.
There is always a lot of talk about the root cause of dry eye issues and i am a 100% certain in case of refractive surgery the cause is ALWAYS not properly healed severed nerves. From there our tear system gets trapped in a downward spiral you just can't escape from.
Indeed ophthalmologists tend to dance around the issue. I unfortunately know that from my own experience.
It is a shame that confocal microscopy by now is not a standardised diagnostic tool to establish the condition of the corneal nerves in patients with dry eye issues who underwent refractive surgery in the past. It should be the first thing to be looked at by doctors the moment they have heard your story.
I recently told this to my current ophthalmologist and she looked at me as if she saw water catching fire! Unbelievable.
Looking forward to read about your experiences with prokera,so please keep us posted. Thanks in advance!

Patrick..

[Phillips55]

Hi,
I wanted to give it about a week before I made any updates. Things were great for the first few days but unfortunately my eye symptoms returned. I am sure that Prokera did what it was supposed to do but the mechanisms that cause my eye problems in the first place were not corrected. I hoped for the best but I anticipated this would probably happen but I do not regret having the procedure. Perhaps the Prokera did provide some benefit to the eye that I cant feel but I have not had it examined yet. I am fortunate to have very good health insurance so I am able to be aggressive in seeking treatment for my dry eyes. Healthcare is so screwed up nowadays that most treatments are are either available but unaffordable, or just unavailable. We in the U.S are generally home to the most cutting edge treatments but you will pay through the nose to get them. And there is no guarantee they will work. I'll report back if anything changes and I'll always try to update when I try another procedure.

The next thing would be eyelid surgery. I want to avoid anymore surgery period but I am running out of nonsurgical treatments to explore. Its' frustrating because I have had three prominent Ophthalmologists tell me that eyelid surgery would be a slam dunk for my eye problems, but the different eyelids surgeons I was referred to told my eyelid issues were moderate and that surgery could make things worse. I really don't know what do.

Regardless, my advice remains to keep trying everything you can in the order of risk/cost vs potential reward.

[patrick]

Hi phillips,

Thanks for your update.
How unfortunate that the prokera is not offering lasting relief.
But you're right. We should try everything we can as long as its within our financial reach.
It is the only way to find out what is working for you and what not. All in all dry eye,despite very good health insurance,is a very expensive business.

I know it can be very frustrating that treatments are either very expensive or just unavailable. However to my understanding the u.s. Is still the best place for finding the latest treatment options,because here in europe we still run well behind on that.

With eyelid surgery you're referring to tarsorrhaphy maybe?

I have an appointment with my ophthalmologist this afternoon. I've been on a 3 months course of tacrolimus ointment (immuno modulator,like ciclosporine but with another mechanism of action).
I guess they are going to run the same tests on me i had many times before. I.e. Sitting at the slitlamp checking staining and measure tbut and what not. Also schirmers of course. I really hope things have improved a little.
3 months of applying some greasy ointment in your eyes 4 times per day that stings and feels uncomfortable and
makes your vision blurry for the next hour or so hasn't been exactly a walk in the park.

I'll report the findings of this afternoon here on these boards of course.

I hope for you you'll find the relief you're after very soon. Good luck with that!

Patrick..

[Phillips55]

Maybe I was a little premature in saying that the Prokera didn't work. Since yesterday things have rapidly improved in my right eye. I don't know if the Prokera has anything to do with it but I do feel less friction when I blink and there seems to be improved tear quality. When my right eye has produced tears, they are the runny kind that run down the cheek. It's been either runny tears or dryness. My right eye now feels like it's moist without being runny. I noticed my eye is not drying out as much when I go outside. I'm hesitant to say it's because of the Prokera because I can't say. But my right eye has always been noticeably worse than the left, and now they both feel about the same, which has never happened before. I'm very aware of the placebo effect, but this is measurable improvement. Ill keep you posted.

[Phillips55]

With eyelid surgery you're referring to tarsorrhaphy maybe?

Patrick I'm told my eyelid problems are threefold. One, my lower lids droop too low exposing too much of the whites of the eyes. The option is to tighten the lower lids. The other problem I have is floppy eyelids which many people with sleep apnea have, which I do. Finally I seem to have too much tissue/ fat above my upper eyelid which is pushing the eyelashes down causing the eyelashes to rub against my eyes. Again I'm told my symptoms are mild-moderate, but I may at some point try the least invasive procedure which is the lower lid tightening. Because getting a little improvement here and there can add up in the end, symptom wise.

[Phillips55]

an AMT to treat CCh is not really a ocular surface reconstruction!

The bulbar conjunctiva does rest - is bound tightly on the sclera - white part of the frontal eye ball.
In healthy eyes with a good tear film, the upper eyelid is gliding down almost without resistance.
In dry eyes the upper lid is moving downward more like rubber on rubber.
Thereby pushing the conjunctiva downwards during every blink.
So the conjunctiva is getting loose and slowly detaches from the sclera.
That is causing CCh and the so called LIPCOF folds at the lower lid margin.
The AM is being sutured onto the conjuctiva-sclara and thus the conjuctiva is being re-attached to the sclera.


I found this in another post, if I am understanding this correctly, this may be what the Prekera helped me with. Like I said I feel like I have an actual tear layer now. Ill keep you posted. Thanks

[Phillips55]

Just another update. The benefits from having Prokera done have not gone away and the difference in my right eye since having it done is like night and day. I still have some issues yet, but for the most part my eye feels like it did before I had Lasik. Wind, Dry heat and AC don't dry it out at all. In fact as I said before my right eye was far worse than the left, and now I notice that when I drive around with all the windows open it is my left eye that I notice drying up fast whereas my right eye feels completely normal. It's like there's this perpetual protective layer of moisture there now that I so took for granted before Lasik that I never even noticed it. I'm not trying to sound like shill for Prokera and I don't know if it will work for you. But for anyone who has had dry eye problems from Lasik I strongly suggest you look into Prokera or any kind of AMT procedure. It was 3 years + after lasik before I tried Prokera and I still saw massive benefits, so if your a new Lasik victim here or even someone who had it done years ago I really would look into it.

It seems like it's generally covered by insurance and it is an extremely low risk procedure. If no one in your area does it ask your Ophthalmologist if he can order one and put it in. It's basically just a big contact that you slide in the eye. The 5 days it was in was a pain in the butt but as soon as I can I'm going to get the left one done as well. The results have been remarkable. If things change or go downhill for some reason Ill update, but right now I'm on my knees thanking God that this has worked as well as it has.

[patrick]

Hello phillips,


Congratulations! That is really good and maybe a bit unexpected news.
Me and i think many others here are very curious to read about your experiences.
So,please keep us posted.

Good luck when you have the procedure done to your left eye as well.

Patrick..

[grant555]

you had it done on both eyes correct? any idea why you are only seeing improvement in the right eye?