Hi there,
I have been reading surgicaleyes on and off for a few years now and find it an excellent forum, and have recommended it to anyone I know thinking of laser surgery. I found it initially while doing some research following my partners laser surgery about four years ago, and thank God all is going well for her so far. Although, having read some of the horror stories, I have steered clear of it myself, despite a consultant giving me the ubiquitous response that "You are a perfect candidate for laser surgery". Yeah right.

However, her sister also had the surgery less than two weeks ago here in Ireland, and it has gone horribly wrong. She had both eyes done, and has picked up an aggressive infection in her right eye. A few days after the surgery she was having a lot of pain in her right eye, which they treated immediately with antibiotic drops. It did not improve and they admitted her to hospital. They performed emergency surgery on her, lifted the flap to clear out the infection and are treating it with a truck-load of antibiotics ever since.

She has been in hospital for a week now, and will be in there for another week at least. They are giving her antibiotic drops every half hour to an hour, 24 hours a day. They have changed the antibiotic three times, as the infection is not clearing up. She is in intense pain and discomfort and is on painkillers to deal with this. Her life is a misery at the moment, and she has described it like having a hot knife in her eye. Her left eye is fine, thankfully.

They have said the infection is Staphylococcal aureus, I believe, and it is very aggressive. The OD has said the worst-case scenario is that she will lose the sight in her eye. The best case scenario is between two and six months of an irritable eye, possibly with some further surgery down the line, with some talk about corneal transplant, but I don't have any more details.

I have read some good posts on this topic here, including the one titled "Post-LASIK Infection-HELP!!!" which gladly had a happy ending. I also got a link to a very good webpage about infection & Lasik here.

The hospital seem to be doing everything they can do, but as the potential outcome is so serious for her, I am researching every avenue. Does anyone have any further information or advice on what she could do?

What about removal of flap? Or cornea transplant? Or any other approach to resolve her problem? Can anyone recommend a good OD in Ireland or the UK, if it comes to that?

Thanks in advance, and congrats to all at the forum for an excellent job.

With such a severe infection, I can't imagine the flap surviving. Flap amputation might improve penetration of the antibiotics.

Thanks Dr. Hartzok. And what would be the longer term implications of flap removal, assuming it did help with fighting the infection? Would this necessitate the wearing of lens' or perhaps a cornea transplant?

quote:

Originally posted by Dr. DavOD Hartzok:
With such a severe infection, I can't imagine the flap surviving. Flap amputation might improve penetration of the antibiotics.

Removing the flap would not alter the prescription appreciably. The epithelium will re-grow over the ablated surface as it does following PRK. The significant infection you describe may very well leave her with irregular astigmatism and require a corneal lens to restore sight. The bigger question will be the scarring and visual distortion. A rigid contact lens (corneal prosthesis) can correct irregular astigatism on the corneal surface but do little for irregularities beneath the surface. If the flap is optically compromised, it becomes one more source for distorted vision.

A transplant would only be indicated if the cornea was so physiologically compromised or scarred so deeply that no other option was viable. I have seen cases where a transplant was recommended but a contact lens worked well. It is best to exhaust, really exhaust, other options before resorting to a transplant. Transplants don't last forever; there is always the possibility of rejection. Second and third transplants seem to last for shorter periods of time. When someone is young, it is best to hold on to the natural cornea as long as possible.

A small update from last night; they are talking about giving a botox injection to her eyelid to make it relax and close, thereby protecting the eye further? I can't say I've heard of this treatment before? Still no major improvement on the infection either.

Since last night (Thursday) it appears that the infection is abating, and the ulcer/abscess is reducing. The pain is also reducing for her, which is great. The OD said to give it two weeks with close monitoring to see how it progresses, followed by a month's rest to allow it to heal, and then see what the options are to recover/repair as much vision as possible. The eye is definitely damaged, but to what extent is not yet clear.

He said the option of flap amputation probably would not provide any great benefit optically, due to the scarring of the cornea underneath the flap. He again mentioned cornea transplant, including a more recent procedure of a partial cornea transplant - does anyone know anything about this please? He mentioned ETX/OTX or some such acronym? Thanks.

A lamellar keratoplasty could be performed to preserve the remaining cornea following removal of the scarred tissue.

Here is a description: http://www.snydereyedoc.com/html/lamellar_keratoplasty.html

Hi all,

I have a pretty urgent request for anyone who can recommend someone for a second opinion on the situation. Things were going ok, but have taken a serious down turn since midweek.

To give a brief update on what has happened in the last number of weeks since the original infection arose: she was in hospital for 2 weeks getting 24-hour dosage of antibiotics to try to get rid of the S.A. infection. They changed the antibiotics a number of times as it was not responding, after initially having surgery to remove as much of the infection as possible. She had injections of antibiotics into the eye and was on a drip to handle this very aggressive infection. Eventually it started to respond, and after two weeks in hospital she was allowed home. There she was taking drops and returning every few days for examination by the consultant. Gradually, the infection started to clear up, and about two weeks ago he said it had gone completely, and they started to wean her off the antibiotics. Last Friday she was taken off them completely and her eye looked pretty good. She had scarring on the cornea, and had about 75% vision in the affected eye. But they were going to give the eye a few months to heal up before thinking about what to do next.

Over the weekend her eye started to get sore again, and by Monday there was pus and pain in the eye. She returned immediately to the doctor (who had not scheduled to see her for another three weeks, thinking the infection had gone), and he confirmed the infection was back. It obviously had not cleared up totally. She has been readmitted to hospital today, is back on the drip of antibiotics and had an injection into the eye. He is talking again about doing surgery to clear up the infectio again.

Obviously this is all very worrying and upsetting for her and her family. At this point, they are considering what else they can do to make sure all bases are covered. Can anyone recommend someone that would be experienced in dealing with post-op infections and can give a second opinion on the best course of action? Ireland is a small place and a small medical community, so perhaps someone in the UK, US or the continent would be more experienced in these matters?

All help & advice much appreciated.

Thanks in advance.

Colm,

So sorry to hear that things are not going well.

In the UK, you might want to call Dr Dan Reinstein at London Vision Clinic. He is quite skilled and very well regarded.

His contact information is:

Prof. Dan Reinstein
London Vision Clinic
8 Devonshire Place
London, England W1G 6HP
0800 587 4705
020 7224 1005

Good luck.

Much appreciated, thanks Barbara, I'll pass it on.

Hi Barbara,

I have been meaning to send you a reply to thank you for your referral to Prof. Reinstein in London. As you suggested, he was indeed very helpful and helped hugely on her road to recovery.

We contacted him immediately after you giving his details and they flew to London a few days later for an urgent consultation. The flap was indeed melting due to the eye's response to fighting the infection.

The first, and most important thing that Prof. Reinstein said was that it was an infection and was not something he could help her with directly himself. He said they needed to immediately contact a micro-biologist, and he referred them to a colleague of his (I can double check his name, but I believe it was Apheck? (spell?)), who saw them immediately.

This doctor said that the eye was so pumped full of antibiotics that there was nothing he could learn from taking a culture of it. But his examination led him to believe that there was another infection going on underneath, which turned out to be the case. There was a herpes infection as well as the SA.

This information changed the treatment dramatically, and they followed his advice religiously. Over a period of a few weeks the eye improved, and they made a number of return visits to this expert in London. The last visit was about a month ago, and at that time he suggested that the eye was probably stable enough not to warrant further surgery. There is some scarring from both the initial and secondary infections, but this had healed to a good degree and he was confident there would be further improvement over time.

Barbara, thank you so much for your referral to Prof. Reinstein, which in turn led to Dr. Apheck. This was at a crucial time, and I have no doubt it saved her from further surgery at a minimum, and further severe damage to the eye was imminent. Prof. Reinstein showed his expertise by understanding that this was a case that required a microbiologist immediately, and thankfully had a top class colleague to refer us to. Unfortunately neither of these things happened with her own OD, and should have.

She is now leading a normal life again and the horror of what she has been through is hopefully ended. The issues of how this was allowed to happen are still to be addressed, and that will happen in time to come. But if anyone in Ireland is thinking of having the treatment done and want the names of the people involved or any other information, please feel free to contact me directly.

This again shows, if proof was needed, of the value of this forum. Thank you.

Colm.

This message has been edited. Last edited by: Colm,

Hello, Colm.

Thanks for taking the time to post your update. It's a relief to know that the situation has been resolved and no further damage was done. Dr. Reinstein is a fine opthalmologist. A truly good doctor knows his limitations, and is not afraid to refer to a necessary specialist.

I'm delighted that things worked out so well, and I thank you for your kind words. Perhaps you'd be willing to post her story in the "personal stories" forum in the free section of the bulletin board above. It's always helpful for others to see what patients have been through, to know the risks and dangers, and to know that sometimes, critical situations can arise that may need urgent treatment.

Best of luck to her and please, continue to tell people about us. You never know when someone will need the sort of help we can provide.