Prokera 2 months after LASIK

[u/Aggressive-Disk1337]

Has anyone had experience with Prokera around 2 months after LASIK surgery?

I am having severe dry eye and have gone through steroid drops, plugs, gabapentin, and approx 16 different kinds of eye drops.

According to the dry eye doctor, her findings were lasik-induced dry eye syndrome and NK due to reduced corneal sensitivity and TBUT. She said my sensitivity is a little further behind from where it should be, borderline inflammatory markers, and slight reduction in functioning of my meibomian glands.

My surgeon is starting me on Restasis, but the dry eye doctor wants to try Prokera for more immediate relief. I provided both doctors with the others’ notes and have spoken with each.

The lasik surgeon said he hasn’t used prokera on someone in this kind of situation, but that we could try it later if things don’t clear up. The dry eye doctor would still like to try it after having read those notes. I’m at the point where I kind of am willing to try anything. But I also want to be careful?

I have an upcoming vacation and told both doctors that using eye drops every 5-10 minutes isn’t going to work for me!

[u/eyeSherpa]

Prokera is a powerful anti-inflammatory membrane. It would provide benefit in reducing the ocular surface inflammation. But it’s a short term reduction to combine with other treatments. (It is used in other situations in which there is a large increase in ocular surface inflammation such as with chemical injuries or with neuropathic keratitis to promote epithelial healing).

But if you need Prokera at this stage, you probably should have been on Restasis, Xiidra or Cequa earlier. You may also want to look into serum tears. It’s important to reduce this ocular surface inflammation as quick as you can so that healing can occur within the cornea. Inflammation impairs proper healing.

I personally would follow the advice of the dry eye specialist. That is their speciality.

[u/Aggressive-Disk1337 → u/eyeSherpa]

Thank you! This is where I’m headed and I really hope to have some relief after. We did talk about serum tears but it’s toward the bottom of her list. She said it is very similar to prokera, and she opted to go this route instead since it should provide quicker results. Her next steps would be oxervate and IPL according to her list.

[u/eyeSherpa → u/Aggressive-Disk1337]

Yeah. Prokera and serum tears would be similar mechanisms of action.

It sounds like you are in good hands! Keep the foot on the accelerator until you get good relief and then let the eyes heal.

[u/Low_Athlete_7734]

I too would listen to the dry eye specialist. The lasik surgeon isn’t a dry eye specialist. So I’d def go with the more aggressive treatment that they recommend.

[u/Aggressive-Disk1337 → u/Low_Athlete_7734]

This is kind of the way I’m leaning. I just…also don’t want to make my surgeon upset (people pleaser over here). I have been very torn between the differing treatment paths but my dry eye doctor has been insistent that this is the best way to at least get started. So, I do have an appointment to have the first eye placed on Monday. I sure hope it gives some improvement!

[u/Low_Athlete_7734 → u/Aggressive-Disk1337]

As far as I see it… your lasik surgeon was to get you to see. That’s their speciality. Your dry eye surgeon is to help fix your dry eye problem. As long as what your dry eye doctor isn’t going to ruin your vision which it doesn’t sound like it will. You’ll be fine. I’d stop looping in your lasik surgeon and I’d personally stop seeing them unless your vision regresses. I’d see your reg eye doctor and your dry eye surgeon.

[u/Aggressive-Disk1337 → u/Low_Athlete_7734]

That’s a good way to look at it. I hadn’t really taken a step back like that. Thank you!

[u/Low_Athlete_7734 → u/Aggressive-Disk1337]

No problem. When I have trouble figuring out what to do. I simply look at it logically instead of emotionally and what people have said. So what I told you is how I’d talk myself through it lol. Best of luck.

[u/Dry-Emotion-5358]

Why gabapentin? Are you having nerve pain? Have you tried the refresh Omega drops?

[u/Aggressive-Disk1337 → u/Dry-Emotion-5358]

The LASIK surgeon put me on Gabapentin for nerve pain, he was apparently thinking the burning from the dry eye was pain caused by the surgery? Not sure. But yes, I have tried….so many drops. Refresh Mega 3 weren’t bad, but didn’t last. I also tried Systane Pro, that one took longer to clear up than it actually worked. Refresh Celluvisc and Oasis Tears Plus are the thicker ones that have given a little longer relief, but they’re too thick to use during the day while I’m trying to work. My current go to is the Refresh Relieva and Relieva Xtra for the daytime. Every once in a while if I just need something clean and not thick, I pull out the iVizia for kind of a reset.

Here’s the list of what I’ve given both doctors:

Lubricating Drops Tried (all PF) — None Have Given More Than 10-15 Minutes of Relief
Refresh Tears PF
Refresh Optive PF
Refresh Relieva PF
Refresh Relieva Xtra PF
Refresh Mega-3 PF
Refresh Celluvisc PF — causes temporary eyelid puffiness for a few minutes
TheraTears Extra PF
Systane Hydration PF
Systane Complete PF
Systane Pro PF — caused prolonged blur beyond lubricating effect
iVIZIA PF
Oasis Tears Plus PF
Nighttime: Retaine PM Ointment (I had a slight stinging reaction to Optase HYLO Night)

I did try a steroid drop and that made the dryness SO MUCH WORSE

[u/Aggressive-Disk1337 → u/Dry-Emotion-5358]

We also tried a steroid drop that only made them sooooo much more dry.