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  • Debridement surgery

    I have recently been to my DR again with yet another recurrent corneal erosion that sends my vision blury for 7-10 days at a time, this is the third one that I have had now since my epi-lasek 12 months ago.

    The DR has suggested but is reluctant to perform (given my dry eye history) a procedure he called debridement.

    Basically he said is like having PRK without the laser. It is a similar procedure to what i had with my original laser surgery as my epithelium was weakened with alcohol solution, pushed aside whilst the laser was applied then repositioned after the laser, however, this time the epithelium will be discarded completely and allowed to regenerate completely on its own.

    It appears that my epithelium is not attaching itself as it should to my cornea which is making it weak and this contributes to these horrendously painful erosions.

    I sleep with an eye mask of a night and put gen teal gel in every 4 hours to get through the night, my day dryness is manageable now.

    I would just like to get some opinions on this procedure to see whether it is something that i am prepared to put myself through.



  • #2
    Hi Ian

    If you do a search on the forum for 'debridement' there are a couple of opinions, not much detail though.

    I know you have been through a lot with this but I would think long and hard before doing anything else. You always know when someone is feeling better because I know you would never have even considered this a few months ago.

    If the doc is reluctant then I would take that into account too.

    You are now manageable during the day so presumably this isnt ruling your life anymore - this is a huge deal, you have actually come along way.

    Plus, I know you have gone increasing lengths between having these erosions so maybe giving it more time is going to be kindest on your eyes in the long run. Im sure this putting gel in every four hours is a pain but theres nothing to say you will have to do this forever.

    When it comes down to it - theres no way to know how you will react to this, it may work out great, or you could set yourself back - its a touch choice.

    Im sorry if this sounds 'lecture-ish' thats not my intention but you have come a long way in the last few months - I would hate you to forget that. Plus youre going home soon - see how you fare there. The change in environment may make a massive difference to things.

    Take care and best of luck


    • #3

      Thanks for your comments. I guess it was just an option that has been presented and you are right, I have come a long way with this. I get through most of my days now without anything at all, I just have horrible nights and I am determined to overcome them as well.

      It is 12 months tomorrow since I had the surgery and I am just feeling a little down about it that it is still ongoing. I heard yet another laser success story today which just doesn't help either.

      Anyway, this is the pack of cards I have been dealt so I just have to play the best hand I can.

      I am so upset because I had another erosion on the weekend which has affected my vision again. This is about the 3rd major one that i have had. Lots of little ones along the way but I can deal with those.

      I am not sure it (debridement) is for me anyway, I will be going back on Tuesday, my vision seems to be coming back under control again, it usually takes at least 10 days for it to settle down again.

      Fortunately, I am not working a lot at the moment, so I am not spending hours in front of the computer.

      I hope the few months in Australia will be good for me so I think I will take your advice and see what happens.

      There is no real conclusive evidence that it will be successfull and given that I was told that my proceedure would be 95% successful, anything less than 100% is just not good enough for me and my eyes anymore. I made 1 big mistake, I am not going to compound that with a foolish hasty decision to try sometime so invasive.

      I will get through this, just another difficult period in my Dry Eye history to overcome.

      Thanks again for your continued support.




      • #4
        Ian, my doc wanted to do debridement on me one year post lasik. I'd had recurring erosions, plus a corneal ulcer. Dry eyes, EBMD and all the rest. Bad vision too.

        Bottom line is that I would not let him do it. I hightailed it cross country for second opinions. That was of no particular help, other than telling me I had dry eyes and EBMD. It sounded barbaric, "with a diamond burr we take off your epithelium." I can't tell if this would have helped ME, but possibly it would have made things worse?

        Wish I could be of more help, but it scared me enough to say no. My doc was in favor or it, remember. He was in favor of lasik, too. So was I. Certainly, take this in steps, second opinions, other alternatives. I hate seeing the very same problems I had so many years ago recurring today on this very bb.
        Don't trust any refractive surgeon with YOUR eyes.

        The Dry Eye Queen


        • #5
          Jeepers creepers, where'd u get those peepers?

          I have this mean ole "map dot syndrome", and I keep getting recurrent corneal errosions that are soooooo painful. My eyes don't close all the way when I go to sleep, (they never have ever since i was a kid) and they dry out so badly. I sleep with swimming goggles on to help keep them moist at night along with putting genteal gel drops in at night. All through the day (like every 15 or 20 minutes) I apply genteal drops to keep them lubed during the day cause they dry out so badly. When I get the "bad" erosions I wear a bandage contact lense (which is a little annoying, but feels sooooo good cause it makes the pain go away by preventing my lid from touching my cornea, but the dryness remains.) And I must say that I have had three different doctors opinions. One said definitely don't do the debridement surgery, one said let me do the debridement surgery on you, and one said i really don't know what to do for you and sent me to the other two doctors. LOL...So from this experience, I have decided that I will just live with using my drops, gel, and goggles and occassional contact bandage lense for as long as I can as opposed to the surgery. Because these treatments are things that although a bit annoying at times, I know I can tolerate and live with them and still have somewhat useable vision. But with the surgery, it only seems to be a temporary relief, and often times a very "short" temporary relief, because everyone still ends up getting the errosions, and some actually get worse and lose most, if not all their vision. So I have decided that I would rather be a little bit inconvenienced by the "treatments" that I use, rather than take a chance on being completely blind. And hey, the errosions are painful enough, so why put myself intentionally through the same type of pain with debridement if it's just going to come back again later?


          • #6
            anchoring down the epithelium; debridement

            I'm one who had a debridement, some time ago, and who suffered no adverse effects. . .The epithelium grew back immediately, and I wore a bandage lens over the site for a month, just to help it solidify. . .The procedure did not cure the symptom I was having (which was a very tiny recurrent erosion or irregularity), but it was relatively harmless, in my particular case. The 24 hours after the debridement were severely painful, of course. . .but my doc (Dr. Scheffer Tseng, at the time) provided a dose or two of Percocet for that. . .

            MORE IMPORTANTLY, there is an established procedure for anchoring down epithelium that does not stay put, which involves using tiny needles that penetrate through that layer and on to the basement membrane, I think. . .It goes by an acronym, and I can't currently recall the name. . .This procedure is quite common, I think, and is not considered barbaric or risky, to the best of my knowledge. . .Does anyone recall the name of this procedure? I'll research it now. .but maybe it's something to consider?
            <Doggedly Determined>


            • #7
              anterior stromal puncture


              Here is an article that describes various mechanical methods for treating recurrent corneal erosions. . .Debridement and anterior stromal puncture (the procedure I couldn't name, earlier) are included. . .

              The article thoughtfully takes into account that patients who may be contemplating such procedures have corneal problems BECAUSE of dry eye, but I worry that the procedures themselves, like LASIK, could contribute to dry eye, in their own way. . .

              That said, I had a debridement (but not the puncture) long after I had developed disabling MGD-dry eye, and it did not worsen my chronic state. . .

              Moreover, if I were dealing with recurrent erosions, at the moment, I am not sure that I wouldn't do something to deal with these seriously, even at the risk of some adverse effect on the dry eye. . .

              And do I believe that even a great doctor could make this choice for me? Not really. . .Our bodies do the oddest, most unpredictable things, at times. . .Sometimes bad, and sometimes good. . .

              As if we don't already face daily challenges . . .

              Anyway, I suspect the same potential Hobson's choice faces those of us contemplating invasive cataract surgery. . .for which reason I'm intent on looking into those interesting NAC eyedrops that are mentioned here from time to time. . .
              <Doggedly Determined>


              • #8
                That's so helpful, Rojzen! I just love reading everything that you post.

                I have rce's due to "m-d-f dystrophy" / ebmd / abmd / Cogan's dystrophy. And, if a treatment of drops does not work for me after a year, I am going to consider stromal puncture. My ophthalmologist said that he has seen success with it.

                As you consider options, Blinded_By_The_Light, you may want to read some of the work that Dr. Holly has done:


                I should mention that the osmotic solutions he discusses are what found the principle of Dwelle eyedrops, which some people here have used successfully to treat the condition of ebmd.

                Also, I was wondering if you have had Lasik, wear contact lenses, and / or have ever had an injury to your cornea. Oh, and, do you have the rce's in both eyes?


                • #9
                  Dr. Holly is the inventor of Dwelle drops, as well as Dakrina and NutraTear. Not sure if you were aware when I read your post. Dwelle has helped quite a few through the erosions. Later, however, the talk of preservatives has added some hesitancy to use these. I've used all of these drops periodically for 5 or 6 years and never had any problems with them (or the preservatives.)

                  This is just my experience and not a *go ahead* and do this anyhow. Some people have been surprised by the healing of erosions by Dwelle, especially.
                  Dwelle and other drops are available from this website.
                  Don't trust any refractive surgeon with YOUR eyes.

                  The Dry Eye Queen


                  • #10
                    Apropos of...
                    Originally posted by liz56
                    I should mention that the osmotic solutions he discusses are what found the principle of Dwelle eyedrops, which some people here have used successfully to treat the condition of ebmd.
                    Originally posted by Lucy
                    Some people have been surprised by the healing of erosions by Dwelle, especially.
                    A blog post...
                    I had a long chat with the guy heading up the clinical for Dehydrex the other day. Quite interesting as it's one of the study types I've long dreamed of doing for Dwelle. It's a shame that a more advanced technology has not had the benefit of rigorous published clinical trials to prove efficacy.

                    p.s. Liz56 - just confirmed with Dr. Holly that he's willing to do a Q&A here. It'll take a little bit to get things organized but hopefully we can start pretty soon.
                    Rebecca Petris
                    The Dry Eye Foundation


                    • #11
                      Yes, Lucy. I know about Dr. Holly and Dwelle; sorry for not being clear. I am so grateful to him!

                      And, Rebecca, Yippee! Thanks for letting me know about Dr. Holly's forthcoming contributions. I must say that his drops, this site, and an excellent ophthalmologist have turned my life around since June. I am still getting erosions, but they are getting "smaller" as Dr. Foulks said in an article in _Ophthalmolgy Review_ happens with the use of Dehydrex <>. And, thanks, too, for checking into that. I hope that they can hurry along that option as well. It's comforting to think that my problem may be able to be managed through drops rather than surgery.

                      I hope that you let us know about Dehydrex as the story develops.
                      Last edited by liz56; 12-Dec-2007, 07:24.