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.



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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.


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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.


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3D models of Lasik and Lasik over RK corneas

The images below are computer enhanced 3-D models of 2 different corneas that underwent refractive eye surgery. The first image is of an eye that was extremely nearsighted (-17.00 diopters) before undergoing LASIK surgery. Instead of having a smooth rounded curvature to it, this cornea is as flat as a table top. The 2nd 3-D image is of a cornea that underwent both RK (radial keratotomy) surgery followed by LASIK surgery many years later. The center of this cornea is extremely depressed as depicted by the blue area in the center of this image. Both of these corneas are so distorted that eyeglasses and conventional contact lenses are not able to provide these patients with functional vision with these eyes. Both of these eyes were fit with scleral lenses which replace these corneas as an optical surface. In other words, scleral lenses behave like new corneas. I am posting these images to drive home the fact that refractive eye surgeries present many risks to patients including life long vision loss. Once corneal damage takes place there is no surgery that can undo the damage and restore quality vision once again. My comments also apply to any new refractive surgeries that recently received FDA approval.


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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.


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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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Five eyes with RK or RK then Lasik

The 4 photos below are of 5 different eyes that underwent either RK eye surgery or both RK and then LASIK surgery. The uncorrected vision in these eyes is extremely poor. In the first 3 photos you can see blood vessels that have grown onto the corneal surface, where blood vessels do not belong. The last 2 photos were taken using a special dye to better highlight the corneal defects. In these 2 photos note the green tinted ring going around the corneal periphery. This is the LASIK flap. The green lines going from the outer cornea inward are the open RK cuts. Still open 30+ years later. All of these eyes were fit with scleral lenses. Many corneal specialists will suggest additional surgeries to address the many complications associated with LASIK and other refractive surgeries. My feeling is to avoid all invasive procedures. Scleral lenses, when properly fit, can change the life for the better of a patient with severe loss of vision and ocular comfort.




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RK 30 years ago, then Lasik, Incisions STILL open

This is a photo of the front surface of an eye that underwent Radial Keratotomy surgery 30 years ago followed by LASIK surgery years later. A special dye was used to highlight the defects (cuts) in this cornea. The straight lines that you see at 12:00, 3:00, 6:00 and 9:00 O’Clock are the open RK incisions. The bright green circular line going around the periphery of the cornea is the outline of the LASIK flap. Needless to say, the vision that this patient has with this eye is very poor. In addition the eye is very dry and presents this patient with significant comfort issues. This eye was recently fit with a scleral lens which has greatly improved the vision and comfort in this eye for our patient. The cuts that you see in this eye are permanent. There is no way to undo the damage to the eye created by these needless elective surgeries. The only thing that we can do is to manage the patient’s comfort and vision as best we can with specialty lenses. Corneal transplant surgery is really not a viable option.

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Lasik over RK Equals Disaster

The images below are of the left eye of the same patient. This eye underwent 2 separate RK surgeries over 30 years ago followed by 4 separate LASIK surgeries. As you might expect the results of these surgeries was nothing less than disastrous. The first photo (taken 4 years ago) shows the RK cuts with blood vessels growing along the inside track of the cuts. The white “hatchet-like image is epithelial ingrowth. 4 years ago I referred this patient to a world renown eye institution where corneal transplant surgery was recommended. This patient declined to accept this advice. The 2nd image was taken today. 12 months ago the corneal specialists at this institution diagnosed the crystalline appearance in this cornea as “Crystalline Keratopathy” (extremely rare complication) and was placed on fortified antibiotics for the last 12 months. The 2nd photo looks exactly like a photo that I took of this eye last year. The 3rd image was taken with a technology known as “optical coherence tomography”. This images shows a cross section of this cornea with a scleral lens over it. In this image you can see the crystalline deposits deep inside the cornea. Over the last year this patient visited 8 corneal specialists from around the U.S. Many of them blamed the scleral lens as the cause of her corneal condition. In addition, a variety of therapies and treatments were recommended to her. With the scleral lens the visual acuity in this eye is clear (20/30). In addition, the cornea is clear with the exception of the crystalline deposits and the patient has no comfort issues while wearing her scleral lens. Since this eye has been stable for the last 12 months I recommended that no action should be taken and that this patient return periodically for evaluations including ocular photography and imaging.



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2 separate RKs, then 4 separate Lasiks

The 2 photos below are of the right eye of a patient who underwent 2 separate Radial Keratotomy (RK) surgeries in the 1980’s followed by 4 separate LASIK surgeries years later. The 2nd photo was taken 3 years after the 1st photo was taken. In the first photo you can see blood vessels growing along the still open RK incisions. The white “hatchet” structure is epithelial ingrowth. These are cells from the corneal surface that got under the LASIK flap (where they do not belong) and began growing. In the 2nd photo, taken 12 months ago, note that the epithelial ingrowth has dissipated. Now the central cornea has a scratched ground glass appearance. 12 months ago, we referred this patient to a world renown eye institution where she was seen by several corneal specialists. A diagnosis of “crystalline keratopathy” was made and this patient was promptly placed on fortified antibiotics. The crystal formations seen here are deep within the cornea and not on the surface. This patient left our geographic area for a 10 month period and recently returned to see the corneal specialists at this institution. Yesterday I was informed that this patient’s cornea has the same appearance as it did last year and that she is still on antibiotic therapy. I was also told that collectively, these corneal specialists have never seen anything like this before. I will be seeing her next week for the first time in a year and am anxious to have a look at her eyes as I have sequential photos of her eyes that I have taken over a 9 year period. What puzzles me is why would a doctor or doctors do so many destructive operations on a single eye and why would this patient allow such outrageous behavior be inflicted on herself?


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