My doctor tore my flap to the axis during my first epithelial cell ingrowth cleaning in my left eye, which subsequently resulted in worse epithelial ingrowth in which he tried to clean it out a second time in which he finally had to refer me to a higher level surgeon who had to amputate the whole flap because of extreme damage. Now I have multiple images and ghosting due to irregular astigmatism and severe dry eye and strain which all causes severe migrains. Does ripping or tearing of the flap occurr often in surgeons trying to clean cells. Thank you for your opinion.
A good portion of my cornea did not show up on the topography after the first cleaning.
Thank you.

Flap injuries during treatment for epithelial ingrowth certainly can occur. As well, flap amputations can be required for a variety of situations.
Following flap amputation, a person can end up with some scarring of the front part of the remaining cornea. Often a procedure called PTK can smooth out the surface and remove the scar.
I wish I had some more answers for you. Please feel free to ask a few more questions.

Best of luck

Bill Trattler, MD
Miami, FL

Dear Doctor,
I had the flap amputated on July 31,2002, should it be fully grown back my now? My topography is still very jagard. The image looks like a distorted star. I still have multiple images and ghosting. My cornea is thin at this point so I don't know if I can have any further procedures. Before the amputation, appoximately one fourth of my epithelium was missing.
I think a skilled surgeon with the right instrument could of lifted the flap more skillfully without ripping a piece off. The first lift was 8 weeks after the original lasik surgery, do you think that was too long? I think when epithelial ingrowth is recognized it should be removed a fast as possible before the flap is very stongly adhered. Thank you so much for your opinion, my life is like I'm always drunk. Denise A. From Boston, MA

Flaps do not grow back. When your eye heals you will probably need to wear a specially designed contact lens. Hopefully a RGP (Rigid Gas Permeable) contact lens can get you to an acceptable quality of vision in that eye.

You mean the epithelium that grows in after flap removal doesn't replace the flap thickness? Isn't the original flap the epithelium layer that grows back? I can't wear contacts - I have severe GPC.
I guess I'm in trouble. Multiple images forever.

Severe GPC can be treated. First - staying out of contacts for a few months can be very helpful. As well, your doctor can prescribe some anti-inflammatory medicines to help reduce the GPC. Once you are back in contact lenses, continuing these anti-inflammatory medications can help prevent the recurrence of GPC.
But back to your current situation. Over a few days, the epitheliul heals over the eye following a flap amputation. Over the next few weeks to months, the entire cornea undergoes a healing process. During this time, the cornea sometimes can develop some anterior scar tissue which can affect vision. If this is the case, one may need surface laser to remove the scar tissue and smooth out the cornea. If the scar tissue does not develop, the wavefront surface ablation can reshape the cornea and smooth things out.

I hope this helps

Bill Trattler, MD
Miami, FL

You are so nice, do you really exist and write these replys yourself? My GPC never diminished in severity and it's been over 20 years. I've tried many lubrications and anti-inflammatorys. One of my doctors says they won't be able to smooth out my cornea because it's too thin. I heard of Custom Ablation Procedure, Donor Cap Placement. But the FDA hasn't approved the Custom Ablation Procedure yet and Donor Cap Placement doesn't sound desirable to me at this point. I think I need time to heal pschologically also. Afterall, I worked everyday of my of life for 25 years. I'm 43 now and totally dismayed about what has happened to my lifestyle. On April 19, 2002 I thought I was going to walk out of the Clinic with a new exciting life full of different opportunities in recreation. Now, I can't even play golf. Thanks again. Denise from Boston, MA

Lamellar surgeries are very challenging, and although they can work out nicely, they are by no means guaranteed.
Can you potentially see a contact lens specialist to see whether a contact lens can be worn to improve the vision?
There are some well-known and well-respected surgeons in Boston who you can potentially see.
They include

Dimitri Azar (he is at Harvard)
Roger Steinert, MD (Ophthalmic Consultants of Boston, Boston)

Perhaps you have already seen them - but they are both considered by other ophthalmologists to be very experienced in helping people with complications following LASIK.

I hope this helps

Bill Trattler, MD
Miami, FL

I'm seeing a surgeon who is directly under Dr. Azar at Mass. Eye & Ear. He is very respected. I trust his future decisions. Thanks for your help.