Lasik Over RK Articles

Three Lasiks over RK

The 3 photos below were taken of the same eye over a 4 year period. This eye underwent several separate RK surgeries followed by 3 separate LASIK surgeries years later. In the first photo note the blood vessels growing along the RK incisions. The white "hatchet" like structure is epithelial ingrowth (epithelial cells under the LASIK flap). The 2nd photo was taken about 2 years later. The epithelial ingrowth is no longer in the same location and appears to have dispersed under the LASIK flap. Instead there appears to be fine "glitter" like particles in the center of the cornea under the LASIK flap. The last photo was taken of the same eye 18 months after the 2nd photo was taken. Now these fine particulate "glitter" like structures have morphed into something that looks like a heavily scratched piece of ground glass. This patient was referred to a major eye institute where a diagnosis of "Crystalline Keratopathy" was made. This year this patient will be receiving a corneal transplant on this eye. "Crystalline Keratopathy" is a rare complication of LASIK surgery. It is very slow to develop and progress.

Lasik over RK with haze and dryness

The images below are of the same eye. In the 1980's this eye underwent 3 separate Radial Keratotomy (RK) procedures followed by 2 separate LASIK procedures about 25 years later. The photo below was taken through a bio-microscope (slit lamp). Notice the dull grey spike like figures going from the corneal periphery towards the center. These are the open, scarred RK incisions. Again, look carefully and you will see a dull, grey "smile-like" image in the lower portion of this photo. This is "epithelial ingrowth". This is due to the cells on the surface of the cornea (epithelial cells) getting under the LASIK flap where they do not belong. It is quite possible for these cells to proliferate years later below the LASIK flap leading to vision loss. The 2nd image was taken with a technology known at "Optical Coherence Tomography" or "OCT". This is a cross section of the cornea with a scleral lens over it. The top 2 curved lines represent the front and back surfaces of the scleral lens. The thick grey curved structure is the cornea. Look carefully and you can see a curved white haze in the center of the cornea toward the right side of the image. This is another view of the epithelial ingrowth. This patient will have to be seen at regular intervals to make sure that the cornea remains stable. This cornea is extremely irregular and has a very dry ocular surface. The scleral lens is the only technology that will allow this patient to see clearly and comfortably with this eye.

RK, then Lasik, next stop Ectasia

These 2 photos are of the same left eye that underwent Radial Keratotomy 30 years ago and years later LASIK surgery. Shortly after the LASIK surgery this eye developed corneal ectasia. Several years after this occurred this eye became inflamed with numerous blood vessels growing onto the cornea, where blood vessels do not belong. Look carefully and you can see many small blood vessels in this cornea. When the cornea is traumatized and deprived of the proper nutrients, blood vessel growth onto the cornea can be expected. Needless to say, the vision (and comfort) in this eye has been significantly compromised. This eye was fit with a scleral lens several years ago. Over the last 3 years this cornea and the vision (and comfort) in this eye has remained stable.

Lasik over RK, then Cystalline Keratopathy

The 2 images below are of the same eye that underwent both Radial Keratotomy and LASIK surgery. I have been taking care of this patient for over 10 years. 2 years ago this opacity appeared in the center of one eye. I referred this patient to a major eye institution where a diagnosis of "Crystalline Keratopathy" was made. This condition is a very rare LASIK complication. This patient was prescribed fortified antibiotics to use over a year. Over the past year this opacity has become more pronounced. This week this patient visited a corneal specialist at another world class eye facility where a recommendation of removal the LASIK flap was recommended. The purpose of this procedure is to culture the tissue to determine what organism (bacteria, fungus etc.) has caused this opacity to occur. Today this patient and I went back and forth texting each other. She told me that this lesion was thickening and the visual haze was more severe. She also wrote " if left untreated it can literally explode in bacteria creating a much worse condition...." " ultimately I will likely need a corneal transplant". she continued " I am at the end of my rope". The first photo was taken 2 years ago. You can see that the opacity is in the line of vision. The 2nd image was taken with a technology known as "optical coherence tomography". This image was also taken 2 years ago. The curved thick grey structure is the cornea. The white streak going through the center of the cornea are the crystalline formations.

RK 30 years ago, Lasik 15 years later

This is a photo of an eye that underwent Radial Keratotomy surgery over 30 years ago followed by LASIK surgery 15 years later. A special green-yellow dye was used to highlight defects on the corneal surface. The green "spoke-like" lines radiating out from the center of the cornea toward the periphery are the open RK incisions, still open after all these years. Due to the resultant poor vision created by the RK surgery, this patient decided to undergo LASIK in an effort to undo the damage created by the RK operation. Note the bright horizontal cut just above 6:00 O'Clock. This cut was done to correct an astigmatic error in this eye. This particular incision or cut created a great deal of pain which this patient had to endure for many years. Note the circular tinted ring going around the periphery of the cornea. This is the outline of the LASIK flap. The fact that this line is tinted lets us know that this area is not completely sealed off but still open. Needless to say, this cornea is extremely distorted, dry and often very painful and has been this way for years. This eye was fit with a scleral lens which has eliminated the eye pain and restored quality vision in this eye. The bottom line to what I have written is that there is always hope to get your vision back no matter how bleak you feel your visual future is. I know many members who are reading my words feel that they have no hope to regain what was lost due to their surgery. Please do not give up or give in to any feelings of depression that you may be experiencing.

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Blurred Vision, Burning Eyes: This Is a Lasik Success?

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