I had LASIK done on both eyes 3 days ago. Starting on post-op day 1, I had a haziness that covers both eyes. My doctor says that it is the Sands of the Sahara, and that he is unsure of what causes this. I would like a second opinion on how serious this is. Could this cause permenant vision loss? When does it go away usually? I have been on Pred Forte q1hr and Ocuflox qid since the haziness started, but it has not improved. Also, my doctor plans on debreeding the flaps. Have you heard of this? Please help....

Dear Sunny,

I had it too, but mine wasn't diagnosed until much later. It took two months to clear up, and I still have some remaining particles, but they aren't affecting my vision. My flap was not relifted.

I was told today by a reknowned corneal specialist that it is caused by bacteria in the cannula, due to improper sterilization.

Your answer implies that something "improper" was done. Nobody know what causes this inflammation. One hypothesis is that sterilization techniques can influence SOS but nobody has ever PROVEN it. There are as many theories about the cause of SOS as there are cases of SOS. My belief is that it is due to excessive oil debris in the patient's own tear film. You see, right now it is more of a religious concept, i.e., what you believe to be the cause. As scientists, we cannot conclude any cause and effect relationship without proof. The use of topical steroid drops and even pills have shown to be successful in a vast majority. Lifting the flap is an excellent idea, particularly if there is no response to aggressive steroids. Don't be confused by this patient's answer: Just because his flap didn't need to be lifted for resolution, doesn't mean yours doesn't need to be. Only your personal doctor can give you advice regarding your specific circumstance. I'm afraid you'll be getting to know your doctor much better than you anticipated. The prognosis, however, is good.
Good luck.
Steven Ofner, M.D.
Eugene, Oregon

Thank you for your replies. I am planning on having my flaps lifted today, hopefully to clear the haziness.

On the contrary, I think my flap should have been lifted. Every opthalmic article I've read about SOS states that at Stage 3, the flap should be lifted and irrigated copiously. There's a video that won first prize at one of the big opthalmological meetings that states the same.

I've heard the oily tears explanation, and I've had an enhancement. Under the slit lamp afterwards, he was able to see oily tears and he relifted and irrigated them out. He didn't see anything after my initial surgery, when I had SOS.

Dr. Maddox feels that it can be caused by an oily black residue from the microkeratome blade. Some surgeons don't wear gloves because they feel the latex powder could be a cause. Improperly sterilized cannulas have been implicated, especially when water sits in the sterilizer overnight and becomes stagnant. Bottom line is that nobody knows what causes it for sure every time, but Dr. Maddox must have been on to something, because he began cleaning his equipment meticulously and stopped seeing cases of SOS in his practice. Centers that have begun draining the water from their sterilizers have seen a decrease in cases.

Somebody should start taking cultures from the relifted flaps and get some surefire answers!

elizabeth
believe me, doctors have been taking cultures- but there has been no consisitent result- and often no bacteria found at all. also, dr maloney did a study which showed that liftng the flap did not improve the viusal outcome- therefore he no longer does this. as you can see, when then are a thousand theories for something, you can be sure that there is more than one cause at the root of the problem. our only saving grace is that the syndrome is very rare.

debra tennen, md

Hi Dr. Tennen,

All I know is that there is something in my eye that wasn't there before. Either my surgeon or the equipment he used put it there. There may be many things that can cause this syndrome. My surgeon has had six episodes in 400 surgeries.

Dr. Maloney said he can fix my eye.

Elizabeth

I am 2 weeks post, and have the feel of dirty film covered contacts on my eyes, But haven't brought this to my surgeons attention, was hoping it was one of those things that go away. Guess I better start asking some questions.

sands of the sahara ? is it very common? if you had it would you /your doctor notice it most likely in a week after lasik?