Q. What treatment can I opt for high degree of corneal opacity?
Hi doctor,
I am a 45 year old male. 25 years ago, I had radial keratotomy on both eyes. After a year, I had for the second time in my left. Later, BCVA in left became 9/10 and right 10/10. Now over a month, I am experiencing a blurry vision in the left with occasional headache and left eye pain. Three weeks ago, I had an eye examination and the left eye vision was 4/10 and right 9/10 not correcting both with glasses. My doctor informed me that there is a higher degree of corneal opacity in the left eye and less in the right. He also saw a coloring matter in the cornea. The RK, 4 incisions, were performed at the age of 16 and now I am 45. My doctor told me that my blurry vision is due to abnormal cornea and the only solution for my case is to try to fix the vision with contact lenses. The results were negative when I tried all kind of lenses such as scleral, soft, hard, etc., the left was only 6/10 and 9/10 right. My doctor said that there is no chance for PTK or corneal transplant. What treatment can I opt for? I have attached my investigation reports, so you can have a better understanding of my problem. Any suggestion will be helpful. I would like to know, is there a chance of glaucoma? Thanks and looking forward for your response.
Hi,
Welcome to icliniq.com.
I have gone through the pictures of your old records (attachment removed to protect patient identity).
By your description, I understand you have some idea about your condition. It looks like irregular astigmatism. This might have developed due to weakening of cornea, which is common after radial keratotomy (RK). This causes distortion of the image like irregular lens. RK might also cause some scarring of the cornea, decreasing the transparency. This is not appreciable in the scans but seen on slit lamp examination or eye pictures.
- Mild irregular astigmatism can be corrected by rigid contact lenses but higher degree and scarring cannot be corrected.
- If it is small and superficial scar with irregular astigmatism then it can be eliminated by photorefractive keratectomy (PRK). I do not know why your consultant refused in your case, remember success is also unpredictable.
- As your profession demands perfect vision you can try PRK or customized LASIK (laser-assisted in situ keratomileusis) to remove scar and irregular astigmatism.
- Glaucoma is less likely in your case. You have to get another nerve RNFL OCT (retinal nerve fiber layer with optical coherence tomography) six months later. If it this in the second visit, it can be considered significant.
Hi doctor,
Thank you for the reply,
I have attached few more examination results. May be you can have a better view of my situation. Please check endothelium cell number for left eye and different astigmatism left eye on various examination. Another doctor told me this is a difficult situation and we can have PTK first to correct cloudiness and two months after PRK to correct hyperopia. The main problem is that the astigmatism is fluctuating into the day. How about my average RNFL thickness? Is it fine? What are the normal values? Some other doctor commented that during PTK with these previous RK incisions the outcome is unpredictable and also can have a rupture of the cornea. What do you think? Sorry to bother you but as you understand it is very important for me. Thanks.
Hi,
Welcome back to icliniq.com.
I have gone through the records (attachment removed to protect patient identity) you have sent. As explained earlier, it is due to corneal scarring which is leading to irregular astigmatism and blurring of vision. As you have adequate corneal thickness, I think customized LASIK is one option for you.
- LASIK removes scars and also corrects your glass power.
- Phototherapeutic keratectomy (PTK) or optokinetic (OPK) should not be done, as these never give full vision and lifelong treatment and follow up is a must. Also these grafts anytime can go for failure and scarring.
- Your endothelial cell count is absolutely normal.
- Glaucoma changes are not seen.
- RE (right eye) visual field looks to be some testing errors.
- You RNFL thickness is borderline and I think if repeated again it will be normal. These are not correlating with visual field tests.
- Average RNFL thickness in normal people can be anything from 80 to 200 microns.
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