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Filamentary Keratitis- PTK complication?
I had PTK end of September because i have granular corneal dystrophy. I had it done bilaterally. My left eye is doing great, but my right eye developed filamentary keratitis. My opthalmologist manually removed it end of October, was told to continue using Durezol, then the filament came back two weeks later. He did not want to remove it at first bec he is concerned about scarring. I wouldnt be bothered about the filament, but it is right on my pupil. After a few days i asked for it to be removed bec I really cannot see. So it was removed last Thursday and was told to use Xyzal and oral Doxycycline BID. I can feel more foreign body now, and my husband noticed that it looks like there is a bubble at the center of my eye. So now I am desperate for help.
What should I do now? Wait another week squinting because my left eye is the only good eye, or seek second opinion? Im supposed to see that doctor for my 3 month post op in December 1st, but my frustration is starting to make me lose my confidence in him. It's hard enough for me to work and I work as a Medical assistant, but I am still hopeful that choosing PTk to avoid corneal transplant is worth it.
What should I do now? Wait another week squinting because my left eye is the only good eye, or seek second opinion? Im supposed to see that doctor for my 3 month post op in December 1st, but my frustration is starting to make me lose my confidence in him. It's hard enough for me to work and I work as a Medical assistant, but I am still hopeful that choosing PTk to avoid corneal transplant is worth it.
Best Answer
This is my comment. With the declining reimbursement rates for eye surgery and the generally miserable economy medical practices are looking for "profit centers". The treatment of dry eye is being championed in the ophthalmology/optometry practice management literature. There are no end of tests to confirm dry eye. It's easily possible to spend several thousand dollars on testing that is really not necessary to diagnose dry eye in most cases. The case studies in these business models indicate 7 figure revenue from large practices going into all those tests in that youtube. I am not a Luddite and am quick to embrace useful technology but I think spending a thousand dollars to diagnose dry eyes and more than that to treat it (this is used for MGD and other forms of dry eyes) is not in the best interests of patients in most cases. JCH MD
No the dry eye causes FK. If successfully treated the filaments stop forming. You would need to ask your surgeon about use of restasis.
JCHMD
JCHMD
I forgot to insert on my previous reply. would FK resolve eventually if dry eye is resolved, or does it need to be mechanically removed all the time?
This relatively new treatment for MGD may be of interest. I have no personal experience with the treatment.
http://youtu.be/zKHsONPlG6c
You do have to tolerate an ad before the video starts (whoever posted this link is profiting) but it is worth a look. Dr. Donnenfeld is very well respected on optho circles.
http://youtu.be/zKHsONPlG6c
You do have to tolerate an ad before the video starts (whoever posted this link is profiting) but it is worth a look. Dr. Donnenfeld is very well respected on optho circles.
Retaine is a new 4th generation artificial tears that has some theoretical advantages. When it comes to artificial tears help is where you find it. I have had patients that hated Retaine that swear by any of the chain generic tears.
Both my wife and I have dry eyes. she has lipid deficiency and tears all the time I have aqueous deficiency and my eyes are dry as a bone. Both of use have had complete relief from Restasis. My wife has been on 7 years me for 2. since it takes 5-6 months to work discuss that early. By using up all the drops in one dropperette you cut the cost by 75%.
Both my wife and I have dry eyes. she has lipid deficiency and tears all the time I have aqueous deficiency and my eyes are dry as a bone. Both of use have had complete relief from Restasis. My wife has been on 7 years me for 2. since it takes 5-6 months to work discuss that early. By using up all the drops in one dropperette you cut the cost by 75%.
Thank you for your response. I tried using the Celluvisc but it was more irritating to my eye. I have MGD which does make sense why I have severe dry eyes. I've been trying the home treatments for MGD to help with my dry eyes, like hot compress and eye lid massages, but it really only helps so much. I have been researching what brands of artificial tears to use (preservative-free). My corneal specialist recommended Refresh, and I also saw on some researches that eye drops with Sodium Hyaluronate (Blink Tears) last longer for dry eyes. there is also Retaine MGD that is made for MGD sufferers that has great testimonials. do you have any familiarity with these brands?
The underlying problem with filamentary keratitis (FK) is severe dry eyes. Treatment generally involves frequent installations of artificial tears, sometimes lubricating gels and even lubricating ointments are used. Tear duct plugs are often used, oral omega 3 (fish oil or kreal oil or flaxseed oil by mouth are often used). In some cases the person is started on restasis but this takes 4 to 6 months before it starts to work.
I would try and see your cornea specialist and tell him/her your desperate and want to move up to a higher level of treatment. Ask about the things I've outlined above.
Also Xyzal is an antihistamine and that has a drying effect on the eye and mouth and generally is not used for FK. Ask about the use of Celluvisc which I have found helpful for FK. If you don't feel comfortable or not help then ask for a second opinion with another corneal specialist.
JCH MD
I would try and see your cornea specialist and tell him/her your desperate and want to move up to a higher level of treatment. Ask about the things I've outlined above.
Also Xyzal is an antihistamine and that has a drying effect on the eye and mouth and generally is not used for FK. Ask about the use of Celluvisc which I have found helpful for FK. If you don't feel comfortable or not help then ask for a second opinion with another corneal specialist.
JCH MD
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