Please revise complicatedeyes.org: Minimal surface disruption can cause late-onset DLK even years after LASIK
Sandy
Please revise your information on late onset DLK on
complicatedeyes.org
> http://www.complicatedeyes.org/dlk.htm
> "Something important to remember is that DLK can occur months, even
> years, after surgery if there is sufficient trauma or disruption to
> the LASIK flap. If you ever have trauma to the eye after having
> LASIK, it is always good to be evaluated by a refractive surgeon."
>
http://www.complicatedeyes.org/_vti_bin/shtml.exe/lasik_complications_search.htm
>
>
> Glenn Hagele - Council for Refractive Surgery Quality Assurance <glenn.hage...@USAeyes.org> wrote in message
> > If you find anything I've posted here or that is at our websites that
> > is not accurate, let me know and I will revise it immediately.
> >
> > Glenn Hagele
> > Executive Director
> > Council for Refractive Surgery Quality Assurance
> > http://www.USAeyes.org
> > http://www.ComplicatedEyes.org
> > glenn dot hagele at usaeyes dot org
> >
> > I am not a doctor.
According to this doctor, DLK even years post-op is not dependent on a
serious trauma to the eye. In fact, she states that just a little
surface erosion can cause this. Maybe Glenn should revise this
information on his website.
OCULAR SURGERY NEWS 6/15/01
DLK not just an early complication
Dry eye and recurrent corneal erosions may contribute to late-onset
DLK.
KOLOA, Hawaii — Though widely considered an early complication of
LASIK, diffuse lamellar keratitis can also occur long after the
procedure, according to anecdotal reports.
"Diffuse lamellar keratitis (DLK) may occur beyond the acute
postoperative period for months or years. Minimal surface disruption,
with or without antecedent trauma, including dry eye and recurrent
erosions, may contribute to late-onset DLK." said Helen K. Wu, MD, an
assistant professor of ophthalmology at Tufts University in Boston.
Dr. Wu described two cases of late-onset DLK here at Hawaii 2001, the
Royal Hawaiian Eye Meeting, sponsored by Ocular Surgery News in
conjunction with the New England Eye Center.
She said it is important to treat LASIK patients who have corneal
abrasions with extra care.
"I think it's important to remember that they can develop this
complication long after the initial postoperative period. Monitor them
more closely for signs of DLK, and we need to be very aggressive again
about treating dry eye and possibly recurrent erosions as well to
prevent this," she said.
Etiology unclear
According to Dr. Wu, DLK, also known as sands of the Sahara syndrome,
can be caused by an infiltration into the interface of
polymorphonuclear leukocytes, as well as multiple other causative
agents.
"In terms of clinical signs, the corneal infiltrates are focal and
multifocal. They're confined, by definition, to the lamellar
interface, and there's no anterior or posterior extension into the
stroma. There's no anterior chamber reaction, and it's typically seen
in the first postoperative week." she said.
Dr. Wu said DLK is an uncommon event that has an uncertain cause.
"The etiology is not clear, but it's felt to be a secondary
inflammatory response to a variety of agents within the potential
space of the flap interface," she said. "Surface disruption may lead
to a potentially severe inflammatory reaction underneath the flap.
Typical DLK can be seen anecdotally even up to 2 years following
LASIK."
Two cases
Dr. Wu presented data on two cases of late-onset DLK. The first case
was a 48-year-old woman with a history of hypothyroidism who underwent
bilateral sequential LASIK.
"We used the (Bausch & Lomb) Hansatome and the (Alcon) Summit Apex
Plus excimer laser," she said. "In each separate eye she had a 50%
epithelial defect and she actually did have the typical DLK in the
left eye present on postoperative day 1. These defects healed well
with bandage soft contact lens wear after a couple of days, and her
DLK in the left eye resolved after 1 week of intensive topical
fluorometholone treatment."
One month after the procedure, the patient lost some of her best
corrected vision and attributed it to dry eye.
"She had mild punctate epitheliopathy and was noncompliant with her
drops, but she didn't want to have lower lid punctal plugs," Dr. Wu
said.
Two months postoperatively, the patient had a sudden onset of redness
and foreign body sensation in her left eye. She was found to have a
focal 2-mm by 2-mm non-suppurative infiltrate in the lamellar area
inferocentrally and mild flap edema.
"We lifted her flap and debrided the infiltrate. We sent the scrapings
for cultures and irrigated the interface with fortified vancomycin and
tobramycin drops, and a bandage contact lens was applied," Dr. Wu
said. She was treated with hourly topical steroids and antibiotics.
Three weeks after the episode, the patient's uncorrected visual acuity
had increased to 20/60, but her best corrected visual acuity had
decreased to 20/30 and she had a mild stromal scar and mild flap
edema.
"About a year later she remains about like this with best corrected
visual acuity between 20/25 and 20/30 with a hyperopic shift," Dr. Wu
said. "In her other eye, 3 months after LASIK, she developed a
non-traumatic epithelial abrasion without keratitis and 3 days later
this abrasion healed. She also had a diffuse mild interface opacity.
She was diagnosed again with DLK, treated with hourly prednisolone and
ofloxacin and she resolved without any loss of best corrected vision."
The second case was a 51-year-old hyperthyroid woman, seen by Roger F.
Steinert, MD, who had bilateral LASIK for high myopia. Seven months
postoperatively she had a superior conjunctival resection for superior
limbal keratoconjunctivitis.
"Three days after this conjunctival resection, she had worsening pain
and blurry vision and she had what appeared to be classic DLK," Dr. Wu
said. The patient was treated with hourly prednisolone and ofloxacin
and did well, she said.
Ragnar Suomi
outright lies wants Glenn to revise his information.
She should revise her brain.
On 8 Sep 2003 08:53:31 -0700, sandyk...@netscape.net (Sandy)
wrote:
Sandy Keller
sterile infiltrates. For one, oil contamination on microkeratome blades is
not sterile. Now if he is just too lazy to spell out all of the things that
have been linked to DLK, he could simply write "crap under the flap" and
he'd be a lot more accurate. "Sterile infiltrates" purposely makes the crap
sound innocuous--harmless--when it is not.
Glenn has also published on his site that it takes serious trauma to cause
late-onset DLK, now proven to be untrue. I expect that he will correct this
misinformation on his site, or I will make sure to point out the inaccuracy
often, since he has set himself up to be an expert on lasik complications.
Glenn is trying to attract patients with complications to his selcected
surgeons and he has a responsibility to portray complications and their
causes accurately, or subject himself and his organization to being called
on the misinformation/omissions.
"Ragnar Suomi" <ragna...@yahoo.com> wrote in message
news:s1aplv0mu205g28p7...@4ax.com...
> >KOLOA, Hawaii - Though widely considered an early complication of
Dr. Leukoma
from a non-infectious etiology. DLK has also been linked to cell fragments
from the contamination of the microkeratome by dead bacteria in the
autoclave. Basically, DLK is probably caused by anything that can incite
an immune reaction in an individual patient. It is an immune reaction and
not an infection, per se.
DrG
"Sandy Keller" <sandyk...@netscape.net> wrote in
news:89892761d6de6c4a...@news.teranews.com:
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>
>According to this doctor, DLK even years post-op is not dependent on a
>serious trauma to the eye. In fact, she states that just a little
>surface erosion can cause this. Maybe Glenn should revise this
>information on his website.
We state that surface disruption may cause DLK, but this is a good
point to clarify for those who do not understand the term's use.
The updated article is available at
http://www.complicatedeyes.org/dlk.htm
Glenn Hagele - Council for Refractive Surgery Quality Assurance
wrote:
>It seems to me that Glenn was trying to differntiate an infectious etiology
>from a non-infectious etiology. DLK has also been linked to cell fragments
>from the contamination of the microkeratome by dead bacteria in the
>autoclave. Basically, DLK is probably caused by anything that can incite
>an immune reaction in an individual patient. It is an immune reaction and
>not an infection, per se.
>
>DrG
You are quite correct DrG, but the USAeyes.org and ComplicatedEyes.org
websites are designed for individuals who probably are not trained in
the ocular sciences. We try to keep in comprehensive, but simple.
Something like what Keller has raised is often a limitation of keeping
it simple and conceptual. The take home message of the paragraph to
which Keller refers is that if you have a problem with your eyes after
LASIK, be sure to be evaluated by someone who understands refractive
surgery.
All things considered, I believe anyone reading the article
(http://www.ComplicatedEyes.org/dlk.htm) will be well informed even
without all the minute medical details.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
her anti-refractive surgery/surgeon/industry rhetoric and is obviously
untrue. Any reasonably intelligent individual who visits our website
will see that we provide comprehensive, but plain language,
information about refractive surgery issues.
Dr. Leukoma
wonder if mild SPK is really enough to incite DLK. Dr. Wu describes a
post-operative patient who had dry eye and punctate epitheliopathy at one
month post-op. She goes on to state that this patient developed DLK at the
two month mark following an acute episode of red eye and foreign body
sensation.
To me, this indicates that the "little surface erosion" probably
degenerated into something more significant. Recurrent erosion syndrome
can by quite painful and inflammatory, even to the point of causing a
secondary iritis and inflammation of the entire anterior segment. Also,
this woman did have an antecedent case of DLK in that eye immediately post-
op. That initial bout might have had something to do with the recurrence.
Of great interest is that both of these patients suffered from thyroid
disease.
DrG
sandyk...@netscape.net (Sandy) wrote in
news:6c5f759b.03090...@posting.google.com:
lasik advocate with flap melt
LASIK, it is always good to be evaluated by a refractive surgeon"
If you have pain from dry eyes anyway that varies in severity, then
how do you know when to see the Doctor? How do you know if you have
"surface disruption" or not? Even the Doctors don't seem to know the
difference between epithelial problems and flap melt. Should you just
go in every month or so? In March, I was told to take muro for 6
weeks and call them "at the end of the year" to find out if a custom
PRK problem could fix my irregular astigmatism. At 3 years post-op
after seeing numerous refractive eye surgeons, as of march none of
them had done an evaluation for dry eyes.
Turns out my tear film break-up time is instantaneous- < 1 second one
eye and ~5 seconds the other eye. I was told they'd only seen a few
patients like this. No-one has done a schirmer tear film test to my
knowledge yet. 3 different refractive surgeons, multiple
optometrists, ~40 or 50 visits over 3 years. One wasn't even equipped
to do it- how can he possibly be following AAO recommendations? Tear
film evaluation- http://www.aao.org/aao/education/library/recommendations/lasik.cfm
What am I paying them for exactly???
Glenn Hagele - Council for Refractive Surgery Quality Assurance <glenn.hage...@USAeyes.org> wrote in message news:<juiplvgkepf847c0o...@4ax.com>...
Dr. Leukoma
the truth when you state that none knows the difference between flap melt
and punctate epitheliopathy, or none was equipped to do Schirmer testing.
On the other hand, perhaps your TBUT and punctate epitheliopathy rendered
Schirmer testing superfluous.
DrG
kpat...@hotmail.com (lasik advocate with flap melt) wrote in
news:b0866067.0309...@posting.google.com: