My wife was 20/20 for both eyes after Lasik, then developed heavy DLK after the first week. She had both eyes flapped one month after Lasik, then saw clearly after the flap left. But both eyes became cloudy again soon. She had the 2nd flap lift on right eye two months after op but no improvement at all. After 2nd flap lift her doctor said because of the inflammations on both eyes we have to wait for white cells to get quit. Today her right vision is 20/400 and left vision is 20/60 (3 months after Lasik). We saw her doctor again last week. Doctor said her eyes are in the stage of regressions. Doctor plan to reduce Pred Forde from four times a day to two times until stopping, then do an Lasik enhancement to get rid of the "Dry out layer of cells". Doctor said this is the first patient he had with such a heavy DLK. I am very concern with another flap lift and Lasik enhancement because the flaps have been left two/three times within three months. My questions are:

1. Should we wait for more time for corneal healing to let white cells disappear by themselves so that she can avoid anther flap lift or Lasik enhancement? Any success cases?

2. Are there other treatments be used to get rid of white cells instead of flap lift or Lasik enhancement? What are the effectiveness and what are the risks?

3. If we have no choice but have to do the flap lift enhancement, what is the chance to get improved? What is the chance to develop new DLK or inflammation?

4. Do we need to get another opinion before the enhancement? Where can we find an experienced doctor for such a check up in our area (Great Washington / DC)?

I appreciate any suggestions from you. Please help us to end this frustrated period so my wife can get back to see, read, drive and work. Thank you very much!

John
(I post these questions on both asklasikdocs.com and surgicaleyes.org and hope to get your advise.)

First - you need a second opinion. The course you have described has been very severe, and is not very typical. There are many things that can contribute to DLK/flap interface problems. One reported situation is when a person's eye pressure increases due to the use of steroid eye drops. This has been shown to be a cause of persistant DLK, so you need to make sure that your doctor has been checking the eye pressure. Most experts recommend checking the eye pressure with a tonopen or pneumotonometer at the edge of the cornea, not over the flap.
One statement I can make - is that no additional laser should be applied until the eye has had a chance to completely recover from the DLK. The inflammation inside the flap can alter the refractive error, and the inflammation needs to be gone for many months (4-6 months) and there should be multiple refractions and topographies demonstrating that things are very stable before considering additional surgery.
One thing you were not clear about was whether the poor vision was correctable with glasses or contacts. Were you providing the best-corrected visual acuities, or was that just uncorrected vision.
Dr. Leonard Friedman is a LASIK specialist who is in the Washington D.C. area, and may be a good choice for a second opinion. He is very knowledgeable about LASIK complications, as he has been answering questions here for a few years, and of course he performs LASIK. His office info is in the doctor directory.

Best of luck. Please feel free to ask a followup question

Bill Trattler, MD
Miami, FL

Thank you doctor Bill Trattler. Here are the updates:

We visited our doctor at the weekend. Her both eyes pressure turn out to be normal (her left eye's pressure was high before, 14 this time), her better (left) eye's vision is 20/50, inflammation is cooling down. Right eye - eye pressure 11, no vision change (20/400), Inflammation is getting better than last time but improve much slower than left eye. The doc said that her left eye is farsighted and right eye is nearsighted. Is this the reason that she can't read? She have tried at home with nearsighted glasses and bifocal glasses, both didn't work.

Our doc also agrees that we will hold for enhancement until the inflammation is completely gone. After hearing all your suggestions and our doc's opinion, my wife will not consider having enhancement for a while. The question is, could there be a second DLK waiting for her after enhancement since her immune system reacts this way? This scares us!

John