Cure for post-lasik tear dysfunction

[Angela810]

Hi all,

A quick bit about me - I have been suffering from severe dry eye after lasik a few years ago, not only that, it's painful! The whole episode has disabled my life dramatically.

I've seen a lot of OD's and each have their own diagnosis.

Today I saw Dr. Alio in Vissum. He was lovely! He prescribed platelet rich plasma straight away. However he also said that I have dysthesia - painful dry eyes. He also mentioned neurotrophic factors. He said that the nerves were growing flat and not into the cornea (or something). He said that although plasma will help, it will not totally alleviate my symptoms. He said he needed to lift the flap, and then I would need to apply plasma for 3 to 6 months, so that the nerves will grow back normally and penetrate into the cornea. He said 80% of people who get this treatment get better. The other 20% stay the same.

I am so scared of anyone touching my eyes after the psychological trauma of lasik. So I am going to ask for a 2nd opinion from my consultant in the UK and I would really like to hear from anyone who has had this diagnosis and/or treatment. What was the outcome - better or worse?

x

[herefishy]

If the plasma treatment is without getting the eye cut, and he says it should help, I would certainly do that before "lifting the flap".

[DryInDenver]

Interesting theory.

I had a flap lift in one eye last October (lasik in July of 2013). The purpose was to get either a foreign object out or treat an infection. I was petrified I'd go back to ground zero with the dryness but so far it seems not to have affected the dryness too much one way or the other.

Some of my fear stemmed from one of the theories that the nerve damage in lasik is from the cutting of the flap. It may play a roll, but I've become convinced the damage is caused primarily from the laser. I've seen enough PRK patients on these boards to support a theory that it's laser caused damage since PRK doesn't involve cutting a flap.

Does Dr. Alio have any evidence this works or prior patients who have had success? Is it just a theory at this point?

In my non-expert way of thinking, it seems certainly plausible that getting some plasma under the flap could help the nerves in the cornea heal. If direct contact is needed though, it might not help all the nerves since you only reach the plane of the flap incision and don't get the same penetration throughout the cornea like the laser does.

I did have one minor complication with my flap lift that you may want to be aware of. I started using blood serum eye drops about 2-weeks post-op. When I went in for my next checkup at week 3, the doctor noticed I had some epithelial cell ingrowth. I stopped using the serum and the ingrowth quit progressing. My doctor and I surmised that the serum was promoting epithelial growth to the point that it was invading the flap. I'm not sure if plasma can do the same thing, but if you are putting plasma under the flap I'd get daily check ups for the first couple weeks to make sure they don't get in there and grow like crazy.

Please share any other information or clinical evidence you get on this.

[Angela810]

Hi there,

Sorry I meant that the Prof. Alio will re-open the flap. This will cut all the dysfunctional nerves that are causing pain and dryness. The theory is that dysfunctional nerves have grown because it was neurotrophic. He will then close the flap and I would apply PRP for 6 months so that the nerves grow back normally - so that I don't experience pain and the dryness goes away.

He has treated lots of patients with niche lasik complications and has had good results. Please google Prof. Jorge Alio at Vissum in Spain. He mentioned an 80% success rate. I have nothing to lose since I am extremely uncomfortable at present. I will keep you posted as to how it goes.

DryeyeinDenver - did you use serum after the flap re-lift or after the initial lasik? Did you use a bandage lens after the flap lift? Apparently these is less chance of epithelial in growth with a bandage lens. When you had the flap re-lift did the Dr. find the foreign object? I only ask because sometimes a foreign body sensation can be a nerve sensation as opposed to there genuinely being a foreign body,

x

[tealeaf]

Hi Angela810,
You mean the doctor is able to tell the difference between the proper and dysfunctional nerves? I have trauma of lasik too (2 years post lasik), so I am scared of lifting the flap again too. However, is really no lost if it can help. Maybe you can ask the existing patients for more information, if they are feeling better, etc. The 20% of patients who stayed the same does not feel worse?

I think my post lasik eyes are sending wrong nerve signals too. One of the eye keeps telling me it is irritated. I don't know if there is problem with the nerve or really due to dry eye.

Do you experience dry eye as well or only pain?

Keep us posted. I want to know more and keeping you in prayer.

[Phillips55]

I've written quite a bit about it on these boards,but anyone who has post Lasik dry eye whether it was 6 months ago or 6 years ago should explore Amniotic Membrane Transplants. I too had terrible post op Lasik dryness and AMT brought me almost back to normal.

[PeterBelgian]

I think its a great idea if you suffer severe dryness from bad nerves regrowth. How much it cost?
from what you have said , your nerve already regrew badly so the only chance to let them regrw in a good way is this one. 80% that you are better. I think it's enough to give a try. Concerning the laser destroying nerves , i dot think that. It's just when they cut the flap...


i have found steveyez who get his PRP at Vissum too , he had coneal neuralgia and after 4 month of use of PRP he was better , he i uing it since 2K13 now. Maybe try to contact him. Prp seems to be far more powerfull than AS. If i were you , i would definitely give a try to this treatment , i will spare some money to try this treatment too.

Thx for all the information..

[DryInDenver]

Concerning the laser destroying nerves , i dot think that. It's just when they cut the flap...

I looked in to this a bit and what I found indicates that nerve damage is caused by both cutting the flap and also from the laser. I say this mainly because I found some studies (such as this one http://www.sciencedirect.com/science...02939405007981) that compare nerve regeneration in LASIK patients vs. those with PRK. Since, PRK does not involve cutting a flap, I assume the nerve damage in PRK patients is from the laser.

As one might expect, this study showed it took LASIK patients longer (5 years) to return to pre-operative densities vs. PRK (2 years). Surprisingly though, at the 1-year mark the PRK patients actually had more nerve loss than the LASIK patients. This study found that subbasel nerve density was reduced by 59% 1-year post op in the PRK patients compared to 51% for the LASIK patients. This shows some evidence that PRK patients had more nerve damage than the LASIK patients but that it healed much faster.

[DryInDenver]

He said 80% of people who get this treatment get better. The other 20% stay the same.

The cynic in me says these odds are too optimistic. If the odds are accurate, I'd fall into the camp of the 20% who stayed the same which might explain my reluctance to believe the odds. However, I hope I'm wrong because that would be AWESOME for so many people on this site.

I am so scared of anyone touching my eyes after the psychological trauma of lasik.

I hear you. That's exactly how I felt going into my surgery. There are some risks with a flap lift that the surgeon should go through with you. After my surgeon walked through them with me, of course I was concerned given my lasik outcome, but the thing that scared me the most was the dryness getting worse. I'm almost 1-year out from that surgery and am happy to report that it did not get worse.

[paras1234]

I think the other post of me also dealing with the same pain as described above.It is some sort of nerve regrowth that is I am experiencing below the eye, which helps me with dryness when pressurized but goes to chronic pain level.Doc said I am suffering with moderate dry eye symptoms , that also when working on computers increases .

[Angela810]

Hi all,

I wanted to post an update on my progress.

I had lasik almost 3 years ago. I developed dry eyes and by year 1 I had started to develop neuropathic pain. The pain was tremendous and raged all across my face. I got migraines from cold air and spent most days in bed with my eyes closed to avoid the sensation of what I thought was dry eye. I was disabled by this completely. Since I had never had dry eyes before the operation I just assumed all that pain was dry eyes. However in retrospect it was neuropathic pain.

Anyways I saw so many doctors, had MRIs, saw ENT etc. No-one could explain what was going on. Then I went to see Prof. Alio in Spain at Vissum to obtain plasma eye drops. I hoped that if the nerves would grow my eyes would not be dry and the pain would go away.

Prof. Alio was really kind and caring. He said that I have dysthesia and the nerves haven’t grown outwards and normally but instead grown up against the flap. So 2 months ago I had a flap lift to cut all the dysfunctional nerves. Now I am using plasma eyes to encourage the nerves to grow normally this time round.

The pain in my eyes have reduced tremendously and continue to get better everyday. I am not going to say I am cured and I know this is early days, so I will post again at 6 months. There is still some sensation of dry eye but it is dramatically reduced to the point where I don’t contemplate committing suicide everyday or cry myself to sleep. I really hope I continue to improve – I definitely feel I am moving forwards everyday.

I will keep you posted.

[Magna]

Angela810 i also have neurophatic pain after lasik, but to re open flap , i still worry it would be make another problem in the future like ECTASIA ( bulging eye ). Does Prof.Alio has explanation about re open flap and ectasia? Thanks for the respon

[Guest]

Then I went to see Prof. Alio in Spain at Vissum to obtain plasma eye drops. I hoped that if the nerves would grow my eyes would not be dry and the pain would go away.

Prof. Alio was really kind and caring. He said that I have dysthesia and the nerves haven’t grown outwards and normally but instead grown up against the flap. So 2 months ago I had a flap lift to cut all the dysfunctional nerves. Now I am using plasma eyes to encourage the nerves to grow normally this time round.

The pain in my eyes have reduced tremendously and continue to get better everyday. I am not going to say I am cured and I know this is early days, so I will post again at 6 months. There is still some sensation of dry eye but it is dramatically reduced to the point where I don’t contemplate committing suicide everyday or cry myself to sleep. I really hope I continue to improve – I definitely feel I am moving forwards everyday.

I will keep you posted.

This is old, so I don't know if you'll see this... but in case you are getting email notifications for this stuff, by any chance can you share an update of how things turned out?