Refractive surgery is just that, a surgery, but it is not done in a sterile environment like other surgeries. When it is not performed in a sterile environment, the chance is increased that some toxin will get under the flap and cause DLK. This is common sense.
Some doctors will say "Oh, but we don't know for sure what causes DLK..." In fact, it is almost certain that an environmental toxin, on the tools used or in the casual office where the surgery is performed, caused DLK. Why? Because DLK tends to occur in "bursts", with more than one patients getting in around the same time, followed by spells where no one gets it.
The common person would ask, "Well, why don't doctors do refractive surgery in a sterile environment?" Good question, considering doctors are in this surgery in order to help people, right? Doctors don't want to do the procedure in a sterile environment because it would have to be done in a hospital, which would cost more and slow down the number of patients they do. If the assembly line is slowed down in this way, doctors would lose a lot of money that they are now milking from this surgery.
Therefore the REAL cause of DLK is greed.

I'm sorry, sir, I have to say that I don't think you know what you're talking about. My surgery was performed not only in a sterile environment but also in a "clean room" environment due to the sensitivity the computer and laser. The keratome, laser, floors and walls were all cleaned with hospital disinfectant that contains triclosan. Saying that any center that is not on hospital property can't be made sterile proves you are sorely misinformed.

I have had cosmetic surgeries as an "outpatient" and these centers are just as capable of building and maintaining surgical suites identical to those in a hospital. Maybe you bargained shopped your LASIK at some cut-rate LASIK factory sporting poor conditions or something and are now trying to purvey some kind of assumption as industry-wide fact. Perhaps you'd like to tell us where your information comes from and what your expertise on the subject is.

I agree that there is a variation in the sterility of cases depending on the surgeon/center. Some doctors choose to not wear gloves (none that I know, but I have heard this). I have only visited a few LASIK centers, but the "sterility" for these center was very high.
At our center in Miami, the room is as sterile as possible. We have a special air filter that removes all particulate matter. As well, we have a machine to precisely regulate the humidity, as humidity plays a role in the results. Of course, air temperature must also be closely regulated.
All personal in the laser suite wear caps, face masks, and sterile gloves. All equipment is completely sterilized, and a sterile, new blade is used on every patient. The patients face is prepped and cleaned with betadine, and after the procedure antibiotic drops are placed.
I have never had a case of DLK, but that just means that I am lucky so far. DLK is a non-specific inflammatory reaction that occurs following LASIK - and it can be caused by many things. The answer is that we know that many things can cause DLK, but there may be situations when DLK occurs that no cause can be identified.
I will be happy to discuss this further. We strive to provide the most outstanding care possible, and employees, family members and doctors in my own practice have had LASIK in our surgery center using the identical "sterile" techniques.

Bill Tratttler, MD
Miami, FL

Obviously it frightens you to think that all your freaky surgeries could be dangerous, so you're going into denial mode. Lasik doctors rarely wear scrubs, and many don't even pretend that their surgical environments are sterile. My information comes from WITHIN the industry, not disgruntled outsiders.
Maybe you should read up on what doctors themselves are saying about DLK. Many believe that it is caused by tools sitting in water overnight. There are many possible causes of DLK, but they are all related to some crap getting into the eye. Surgery on the eye should not be done in an environment any different from the environment in which heart or brain surgery is done.

You still haven't proven that you're to be believed. How do you know that laser eye surgery should be done in the same environment as deeply invasive surgery? The surgeries can't even be construed to be in the same class. How do you know that LASIK doctors don't wear scrubs? I was in a sterile environment and my doctor and all his staff were in scrubs. Every person I know who has had LASIK across the country has described their doctors wearing scribs. If you think your pathetic little troll is going to scare people away from having LASIK and you're going to get to some sense of power over them for it, think again. These kinds of boards are notorious for attracting people like you who have nothing better to do with their pathetic lives and spew dysinformation and their own faulty assumptions, and try to pass them off as absolute fact by saying they have some insider connection. You aren't the first, sweetheart, you aren't original, and you won't be the last. Dr. Trattler can easily pull these articles and that's the end of your power--the delete key. Get a new hobby. You aren't very good at this one.

I understand everyone's points. I agree that LASIK is a serious surgery, and should be done under sterile conditions. At our laser center and at the office of the laser centers I have visited, the procedure is performed under sterile conditions with surgical caps, face masks, and sterile gloves. All of the equipment is sterilized prior to each case, etc. We certainly do not leave instruments soaking over night.
On the other hand, there have been reports from surgical centers where sterile protocols have not been followed.
What this tells you is that as a consumer, you should be aware of these issues. There are very legitimate questions to ask your LASIK surgeon.

I am happy to answer further on this subject

Best of luck

Bill Trattler, MD
Miami, FL

Hi Carlene - I have to tell you that I have become a big fan of yours! You are very well-informed and seem to have a big heart, in that you take the time to really try to help your fellows on this site. I even now refer patients to your responses and save them to email at future dates, because of the excellent content and manner in which you get at the heart of the subject matter.

Additionally, I get such a kick out of your responses, like this one. I believe most of us truly have each other's best interests in mind and sometimes we tend to take things personally - I know I have been guilty of this in the past. Keep up the great work! You have become a joy to look forward to. I am sure Dr. Trattler would agree in many ways.
Very sincerely,
Suzette

Thanks Suzette. I try to put forth a logical and unbiased point of view, but I do get my knickers in a twist when I see an obvious troll. While I'm sure most people can recognize a troll when they see one, I can't keep myself from pointing it out in case they didn't. I also don't like people attempting to use personal information I give to be helpful as a weapon against me. While I like to think Dr. Trattler is glad I try to help and sees some of my posts as helpful to the readers, I'm sure he'd like to turn me over his knee when it comes to some of my others.

Well, I must say that this is the most entertaining sequence of messages I've read lately! Well said, Charlene.

As for D. - Warner Robins, if you think hospitals are sterile, you need to read a book called something like "the Church of Medicine" that came out in the early eighties. The conditions described are *still* prevalent.

I'd rather trust my well-being to a doctor in his own surgical area, on whose head lies full responsibility for the facility AND the procedure. 'Course, I'm smart enough to look around and check it out.

I have had 3 surgeries on my feet that were done right in the doctor's office.

For my lasik, I was brought into a climate controlled room, everyone had hair covered with those lovely shower cap thingies. It seemes far more clean than operating on my feet in the exam room.

Perhaps different doctors use different procedures, but I did not have any problems with the cleanliness of the Laser suite.

Denise

LASIK is a surgery on the eye, and should be done under sterile conditions (which is how is generally is performed). The eye is cleaned prior to surgery with betadine to eliminate bacteria, and then the eyelashes are draped so that they do not get into the surgical field. All of the instruments are sterilized prior to surgery, and of course are re-sterilized for every procedure. The blade should be brand new (and thus sterile) for every patient.
Some doctors do not wears caps or masks, but most (including myself) do. We also keep the operating room at a specific temperature and control the humidity as well with a special machine - to make the laser work the same for each procedure.

I hope this helps

Bill Trattler, MD
Miami, FL

Well, if I can't be informative, I can at least be entertaining. ;) I prefer the former, though.

As for my "horrible" procedure in a "totally cruddy" environment, I just had my 3-month follow-up. Starting out at -6.00 with moderate astigmatism, I am now "plano" with a teensy bit of astigmatism (-.25x115 and -.50x70). Combined vision 20/20+3. I still have striae in my left eye, but it's not as bad as before and my vision is still 20/20. The striae in my right eye seem to have resolved themselves.

Will wonders never cease.

So glad to hear your eyes are doing better.

I got severe DLK and I paid $4400. Avoiding discount centers doesn't guarantee you a safe surgery. This "crap under the flap" has been linked to dead bacteria in the instrument sterilizers in many cases. NOT a pleasant thought that I have someone's dead bacteria inside my eyes!!

First of all - I disagree with your blanket statement on the cause of DLK. DLK is a non-specific inflammatory condition that can occur after LASIK. I have had only one patient get DLK - and this was a mild case - and thought to be due to an overlying epithelial defect. The most common cause of DLK from talking with other LASIK surgeons is in association with an epithelial defect (corneal abrasion). In these situations, the inflammationr resolves quickly once the epithelium heals.
There have been some reports of DLK where a number of patients had DLK on the same day. It was thought to be due to a problem with the sterilization process - and it was the sterilizer not the surgeons, who were at fault.
You can be angry that you had DLK, and I personally am sorry that you had this problem following LASIK. We are happy to answer any specific questions that you might have here.

Best of luck

Bill Trattler,MD
Miami, FL

Dr. Trattler,

You are just about as sorry as my surgeon is. NOT! He even said that it could have been talc off his gloves. Would that be MY fault?

I did not make a blanket statement. "In many cases" is what I said.

It really doesn't matter what caused it. The point is that people who don't have LASIK don't have eyes ravaged by DLK, do they?

So you want to indict the entire procedure and industry because you had a poor experience? If the world operated the way you seem to think it should, people will have to start checking their pagers and cell phone at the box office because of the one or two who continue to let them ring and talk on them in the theater. People will have to drink lukewarm coffee because one or two people spill their hot coffee in their lap. And people who will will benefit from LASIK will not be able to have it because one or two suffer from complications.

Your assertion of "many" seems to be an attempt to comfort yourself by not being the only one. Well, you aren't the only one and it's unfortunate. But it's by no means a widespread epidemic. Bad things happen to good people and while it is always a tragedy it is not always someone's "fault." It was a risk and you accepted the risk by having LASIK. Let others accept or reject the risk for themselves, but please don't go around yelling that the sky is falling because something befell you. It sucks to be in a minority, but you are. Go on with your life.

Ok now that I have DLK what is the best way to cure it? Can it be curred? Medicine? re-flap?

I can only assume it was your doctor who diagnosed the DLK so I'm confused by the question.

I saw in another area that you had a recent treatment following your initial surgery. I have asked for a variety of information on that other post so that I can better answer your question.
As well - if you have DLK - please find out what "grade" it is (that is - how severe it is)

Thank you

Bill Trattler, MD
Miami, FL