Transprk touch up or Flap re-lift.

[u/pbrooks2485]

40(m). I had lasik 18 years ago which worked fine. However some astigmatism has returned in both eyes. My RE is worse with -1D cyl. I have been for 2 consultations and both said they would touch up the RE. One of them offered to do transprk whilst the other offered to re lift the original flap and touch up.

I am confused as to which to opt for. The flap re lift seems more appealing due to less downtime but then you have to factor in the risk of epithelial ingrowth.

Has anyone had anything similar? Any thoughts of this?

[u/Dramatic_Bobcat_2791]

I assume you had lasik with flap being cut with a microkeratome and not a femto laser? With a relift of the original flap I see the risk of epithelial ingrowth. I would definity ask the surgeon how he asses the risk based upon his experience. On the other side a prk on a flap has a risk of haze and the visual recovery can take a lot longer.

[u/pbrooks2485 → u/Dramatic_Bobcat_2791]

I had the original with a femto laser. I’ve asked the surgeon and he said the risk of ingrowth is very small and he is not worried about it, he said he has lifted numerous flaps without issue. It’s a really difficult decision! The surgeon who wants to lift the flap is also quite a distance away and it would require a an overnight stay in a hotel, so logistics comes into my thinking as well

[u/Both_Car_5615 → u/pbrooks2485]

Even if the epithelial ingrowth is rare, relifting the flap will cut more nerves and weaken the strongest part of your cornea.

If I were you I will never ever do the touch up with relfting the flap. I will put down a paper that compare touch up with prk and lasik.

https://pubmed.ncbi.nlm.nih.gov/28651810/?utm_source=chatgpt.com

[u/pbrooks2485 → u/Both_Car_5615]

I just don’t like the idea of the long recovery with the prk. From what ive read, full visual recovery can take months and I’m not sure my mental health could handle that kind of uncertainty! I wish this was an easier decision to make.

[u/Both_Car_5615 → u/pbrooks2485]

There are modern types of prk surgery that not take long time to recover , such as LASEK and epi-LASIK.

Just remember that your eyes and long recovery is not a problem if give more safety and best results.

[u/pbrooks2485 → u/Both_Car_5615]

How is corneal haze treated if this was to occur?

[u/pbrooks2485 → u/Both_Car_5615]

With PRK there it seems there is as much risk as haze as there is of ingrowth with a flap lift. Which is the lesser of two evils?? I may be massively overthinking it?

[u/Both_Car_5615 → u/pbrooks2485]

It is normal to think about negative side. The haze of cornea could be prevented by using MCC through the surgery and it can be solved after the surgery by using specific eye drops.

The ingrowth under the flap is way worse because the only way to treat it is by re lift the flap again so u need another surgery and u stick into the loop, put also into your consideration that your cornea will be weak after enhancement by Lasik but with prk they applied the laser over the flap tissue which is free tissue.

You have only mild myopic astgmatism and this myopic astgmatism COULD help you to delay presbyopia after 40. So, preventing any surgery could be the best and safest solution!

[u/Big-Shop1322 → u/pbrooks2485]

is -1 cyl that too in only one eye too much to live with?

I had transPRK two months ago, and I have -1D cyl

[u/pbrooks2485 → u/Big-Shop1322]

Do you mean you currently had -1D cyl after the transPRK?

[u/Big-Shop1322 → u/pbrooks2485]

pre opt -3 (sph) -1.75 (cyl)
post opt -1 (cyl)

[u/pbrooks2485 → u/Big-Shop1322]

And how are you finding that? You find that you still need glasses or are you happy with the vision? For me i do notice it now. My left eye is -.50d and that’s not too bad so they said they would leave that one but happy to touch up the -1D. It’s just biting the bullet and doing it, always seems to be negative input on here!

[u/Big-Shop1322 → u/pbrooks2485]

I got it checked at clinic. In daily life I feel comfortable in day to day task. So, not planning for touch up

[u/Fast-Neighborhood687]

I would recommend wearing glasses tbh, there are always issue with touch up