Does the Presence of a Few Small Papillae and a Mild Allergy Response Automatically Rule Me out of PRK Eye Surgery?

Question

I developed GPC in september 2011 and ceased wearing contacts. I was set to have PRK surgery in November 2011 but my surgeon suggested that i wait until the winter months for my eyes to settle down. My eyes feel quite good but i suspect that a very mild allergic response may be still present . My optometrist checked my eyes recently and reported a few small papillae under both lids. I ceased using medication [ Zaditen ] about 4 weeks ago and have been using Refresh drops daily for mild dry eye.

Michael K. Tracy, MD · Answer

It is best to wait until your allergic reaction is fully resolved. Allergies can lead to eye rubbing which can be dangerous after refractive surgery as well as dry eyes which are a risk factor for regression. Better to wait now than to have a complication later on!

Emil William Chynn, MD, FACS, MBA · Answer

your surgeon was incorrect that GPC is a contraindication for refractive surgery

	in contrast, it's actually the reason many people get LASEK, as they cannot tolerate their contacts anymore, and are actually allergic to them (or the solutions) or using them makes their environmental allergies worse (by trapping allergens in the contacts)

	as dr cohen correctly said, but i want this to be more clear, after PRK or LASEK or even LASIK you'll be on steroid drops anyway, which will totally wipe out any allergy going on, and get rid of any GPC or residual papillae. so again, this is NOT a contraindication to doing the surgery, but rather an indication for doing it

	i would not go to an optometrist either, since you are essentially a preop patient. optometrists don't attend medical school, are not surgeons, and cannot legally operate on anybody's eyes.  while they are nowadays reasonably competent in medical eyecare, it makes no sense to see one preop, when they are not as well-versed as a surgeon on your preop care. so you should probably see your potential surgeon for your preop evaluation regarding your GPC

	i am somewhat concerned that he gave you incorrect advice to wait until the winter, and also didn't tell you about the steroid drops, and also is still performing PRK, which i consider an archaic form of surface ablation that has largely been replaced by Advanced Surface Ablation techniques (LASEK and epiLASEK). it may be the case that he is a general ophthalmologist performing refractive surgery, which is certainly fine, especially if you live in a rural area and not a city.

	however, if you live in a city, you can certainly find a surgeon who has completed a fellowship in Cornea and Refractive Surgery, specializes in it, performs 1,000 procedures a year, and had successfully transitioned from PRK to LASEK or epiLASEK (i did my last PRK in 1999, to give you a frame of reference). i would recommend that they also be a member of ASCRS and do not have a different, irrelevant subspecialty (like glaucoma or retina or eye plastics)

	hope this helps you understand that GPC is an indication rather than a contraindication, and how to choose the most qualified surgeon available for your preop and op care

Ilan Cohen, MD · Answer

No, mild allergic conjunctivitis does not automatically rule you out of having PRK. So long as the inflammation on the conjunctiva is not severe enough to affect the healing of the cornea or the stability of the bandage contact lens, you should be fine. You will be using steroid drops after the surgery which will help resolve the conjunctival inflammation as well. Check back with your surgeon.

Does the Presence of a Few Small Papillae and a Mild Allergy Response Automatically Rule Me out of PRK Eye Surgery?

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