I had lasik on my left eye on February 29, 2000. The day after, my vision was 20/25 in that eye, which is where we were aiming for monovision. My regular doctor did the follow up that day and noted some inflamation. She increased the strength of my cortisone drops. She saw me again on Friday and the inflamation had increased, so she sent me to my surgeon. He said I had "sands of the Sahara" and increased the frequency of the drops from four times a day to every 2 hours. On Saturday I noticed a clearing of my vision. During these four days, my vision remained 20/25.

On Sunday morning, my vision was still good, but began to deteriorate. By afternoon it had changed so much that I called my surgeon and he saw me that evening. At that time, my vision had gone to 20/40 to 20/50 and not sharp at that level. It is not sharp at any distance, and will not improve with refraction. My surgeon says that the curvature of my eye is flatter at the bottom and steeper at the top, and this is causing the vision trouble. He says it is possible that the inflamation has healed in some areas and not others, and that it may correct itself. However he admits he has never seen anything exactly like this.

I saw him again this past Friday and there was no change. He still believes it is too early to rule out the possibility that this will correct itself.

My surgeon was recommended by several of his patients, and the director of pharmacy at his clinic is a personal friend of mine and says he is the best. I have no real reason to doubt him, but since he hasn't seen this before I figured it couldn't hurt to do some research.

Have any of you seen a case like this before? Are we taking the right course of action?

Jeff

Understanding time course of DLK can help eliminate visual loss
Proper identification, staging and intervention is crucial.
by Eric J. Linebarger, MD; David R. Hardten, MD; Y. Ralph Chu, MD; and Richard L. Lindstrom, MD
Special to Ocular Surgery News

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September 1, 1999, Ocular Surgery News
http://www.OcularSurgerynews.com

---DLK also is known as shifting sands phenomenon or Sands of the Sahara Syndrome. (Figure 1)

---A striking characteristic of DLK is a white, granular appearance. (Figure 2)

With the volume of laser in situ keratomileusis (LASIK) procedures growing exponentially, there is an expanding role for ophthalmologists and other eye care providers to be aware of an uncommon post operative condition known as diffuse lamellar keratitis (DLK), which has the potential to derail an otherwise ideal outcome.

Understanding the time course of the disease, along with proper identification, staging and intervention, can help eliminate visual loss associated with this condition.

Background

Stage 1 DLK is defined by the presence of white, granular cells in the periphery of the lamellar flap, with sparing of the visual axis. (Figures 3A and 3B)
The first anecdotal reports of a mysterious post-LASIK inflammatory syndrome began to surface only a few years ago, which is when LASIK began to rise in popularity and acceptance among patients and physicians. Maloney and Smith were one of the first to report on this unusual syndrome at the 1997 American Academy of Ophthalmology meeting in Chicago.

The condition would eventually come to be known by a variety of names, including shifting sands phenomenon or sands of the Sahara syndrome, alluding to the white, granular appearance with waves of increased density (Figure 1).

Since then considerable amount of speculation has been focused on possible etiologies (Table). Anecdotal reports of case clusters seem to point the finger toward a contaminant in the lamellar interface introduced at the time of surgery.

Still more cases appear to be associated with epithelial defects at the time of surgery or even delayed epithelial abrasions occurring weeks or months later. This cumulative evidence suggests that no one agent is completely responsible for the syndrome, and that a multifactorial etiology is likely.

Despite efforts to eliminate potential causes of DLK, an increasing number of cases are being reported as the volume of LASIK procedures performed worldwide continues to grow. Although difficult to accurately document, the authors’ own experience suggests that the incidence of severe vision-threatening DLK cases may be in the range of 1 in 5,000, while very mild cases may be as frequent as 1 in 50.

The authors’ experience in a high-volume LASIK practice has provided significant insight into this elusive condition, along with a strategy to successfully identify and manage this uncommon yet potentially sight-threatening complication.

Our treatment strategy is threefold, and includes identifying cells in the lamellar interface, staging their location and severity, and intervening at the appropriate time.

***Please go to ocular surgery news at

http://www.OcularSurgerynews.com

for the rest of the article

Thank you

Bill Trattler, MD
Miami, FL

Thanks, Dr. Trattler, for your response. Unfortunately, it may have been a bit late for me.

Obviously, you cannot diagnose a condition without an exam. But if a qualified surgeon were to examine my eye now, after I have lost 3 lines of best corrected vision, would he/she be able to determine if my vision loss is a result of not treating DLK aggressively enough?

Also, my doctor believes that my vision loss is due to a slight thinning (10 microns as measured by ultrasound) of the cornea in one area. Is this a possible result of DLK? If so, would it really be treatable by one of the scanning lasers being tested for treatment of irregular astigmatism?

Thanks again for your help.

Jeff

Hi Jeff,

I feel for you. I had Sands of Sahara too, and my cornea thinned enough that I ended up at +6.00 hyperopic.

My case was not recognized soon enough, and then not treated agressively enough, and I ended up with a host of other complications. I've had three surgeries to remove flap wrinkles caused by the DLK, and I have severe multiple images now, caused by a para-central island and/or irregular astigmatism. I am now seeing a world-class surgeon and am being told that I will probably have to wait at least until the end of the year for the techology to fix my eye any further. My cornea is thin and so I don't even know if that will be an option.

The saddest part is that my pupils dilate to 8 mm with a Colvard, so I should never have had lasik in the first place. Unfortunately, no one measured them before my surgery. Even if we get rid of the multiple images (19 at last count), my dim light vision will never be the same. Just being indoors is miserable. Feel free to email me if you'd like further info about the SOS.