corneal melting

[alessia7]

Dear Dr,
my sister had prk on both eyes almost 5 months ago in Italy. Following the operation, the doctor said she had  a complication called corneal melting. He treated her with steroids for  more or less a month. Another doctor said she had central toxic keratopathy. After almost 5 months, her vision is still very poor and extremely blurry. At the last visit, 2 days ago, the doctor said her corneas are very irregular (irregular scarring) and she has opacity on both eyes. He also said that the situation is not likely to improve in the next months (while I read some literature saying it can improve in the 1 year following the prk) and he also said that a transplant would not work in her case because it would be too risky. what can we do? I am desperate for any information/suggestion  and I see no way out of this situation... by the way, they still do not know the cause of this complication.
Any help would be highly appreciated.
Thank you so much,
A.

[alessia7]

Actually, the specialist who visited her said it is no melting but central toxic keratopathy which caused the melt, would this make a difference?

He also suggested the only solution is to try contact lenses, what is your opinion about this considering she had prk 5 months ago, is it too early to wear lenses? could this harm the cornea healing process (if there is any?).

thanks  

[alessia7]

Dear Dr Kutryb,
thanks for your reply. The specialist said that because it was a reaction of her body to the laser it is not recommendable she will have any type of enhancement or transplant.

The melting was stopped in the next days following the prk and it did not lead to perforation. What she has now, as a result of it, is irregular cornea (What I mean is that at the moment there is no melting). The expert who visited her in Italy said that there is nothing to do and he did not foresee any future improvement.

No problem to travel a long way, anywhere they can heal her. Pls could you suggest a super specialist at a major university teaching hospital, a major expert in this field in Europe or in US?
Thanks a lot,
A.

[Michael J Kutryb, MD]

This is an awful sitaution and I am very sorry.  From what you have told me, it sounds like corneal transpantation surgery would have been one of the main  possibilities but maybe not from what you said.  There is a treatment called collagen crosslinking that may be of use a some point perhaps.  I wonder if there may need to be some degree of systemic treatment perhaps with immune modulating drugs to control the melting but this would require a super specialist at a major university teaching hospital.  This is an extraordinarily rare and complex scenario and I'm sorry but I don't have much specific advice other that she really needs some major experts in this field and may need to travel a long way possibly.