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Outstanding 1 Month Visit – Corneal Transplant Follow Up

I had my one month (and a week) visit to Doctor Holland today and all went very well.   He said my transplant was healing better than most, and my vision continues to improve.  The astigmatism is taking front and center but they said that this will begin to be addressed in my next appointment when a few sutures may be removed.  This is done strategically based on the topology.  Dr. Holland told me this was the reason he uses so many interrupted sutures… it allows for “Suture Roulette” where he can tweak things very precisely while keeping sutures in place to allow healing to continue.

I didn’t get the number, but could see some pretty small letters via pinhole.   Interestingly, I learned that the pinhole is a measure of  “potential” vision or “correctable” vision.  So I have some seriously high hopes!

The only concern was a minor increase in interocular pressure (trend…18 to 20 to 27 mmHg) – both doctors say that this is due to the Durezol steroid (I have been on a high dose) and it was nothing to be alarmed about.  They changed my steroid to Pred Forte – a weaker steroid – to manage this.  I was told that around 8-10% of patients fall into a category “Steroid Responders” – a genetic condition… who have a pressure response to steroids.   I had no inflammation on my eye so the reduction in steroid should not have any downside.  They told me that I was out of the high risk timeframe for “RSVP” type symptoms and that the steroids are there just to prevent any chance of rejection.

I mentioned my itchiness and they said I could take Zyertec for it… but if that didn’t do the trick they’d subscribe an allergy drop.  I don’t like adding variables to the mix if I have a working solution, so don’t plan to ask for the drop unless things get bad.

I was also told I could stop wearing a shield at night if I wanted.

As far as how I feel – It’s great!   I can drive at night and have very, very little pain.  I have no complaints at all and so far I’m very, very glad I had this done.

Back in six weeks!

 
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Posted by on April 14, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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Changes in Focus – DALK Corneal Transplant Update

Lexington is full of these horses - all sorts of themes - done by artists. I'd not really noticed how many before... now I take a good long look at the incredible detail.

I really never realized how much discomfort that my Keratoconus caused me – especially when it came to daily activities, routines, etc.   I am thrilled with the way things are going.   The drops are a hassle and so is the nightime shield, but every day is better.    Things get itchy a couple of times daily, but that might just be due to Springtime in Kentucky rather than the sutures, etc.  No pain, no redness.  I am getting anxious to get a new prescription, but I know this would be wasteful as my vision fluctuates.  I realize also that I am going to need reading glasses – more related to my age than my eyes.

The real risk I guess is that I’m constantly forgetting I had the graft – I must remind myself to wear the shield at night and to use the drops – I use my iPhone to remind myself (and my wife helps.)  My eye used to be the focal point of each day – now it just focuses on life for me.

 
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Posted by on April 3, 2011 in Recovery, Surgery-Story

 

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Cornea Day in San Diego – DALK Practice Expansion Recommended

I saw on the web today that Cornea Day in San Diego happened yesterday.  Edward J. Holland, MD and W. Barry Lee, MD did a panel on surgical techniques.  Dr. Holland had told me that he planned to do this, specifically that there was a section about how more corneal surgeons need to master the DALK/Big Bubble technique in order to leverage its advantages.

“Despite the technically challenging aspects of deep anterior lamellar keratoplasty, the big-bubble technique can and should be mastered, a presenter said here.  “Corneal surgeons must add DALK to their surgical scope,” W. Barry Lee, MD, FACS, said during a presentation at Cornea Day, which preceded the American Society of Cataract and Refractive Surgery meeting. “Get familiar with the big-bubble DALK steps.”   Dr. Lee discussed Anwar’s big-bubble DALK technique, stating that the main goal is to place an air injection posteriorly into the stroma to provide contrast between residual stroma and Descemet’s membrane. The surgeon should create a paracentesis to release pressure and inject a small air bubble to confirm the successful placement of the big bubble, according to Dr. Lee.”

I hope to ask Dr. Holland how the event went – and perhaps even get a copy of the transcript.

 
 

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Keratoconus Contact Lens Archeology

Check out all the contact lenses I’ve tried in my journey with keratoconus. This is probably 1/3 the actual count.

 

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Corneal Transplant – 2nd Follow Up with Dr. Holland

Cross-section of Corneal Tissue (approximate)

It’s now been 8 days since the surgery.

I worked half a day and went, with Heather, to Edgewood to see Dr. Holland for my “1 week” follow up appointment.  The Cincinnati Eye Institute office was very busy.  We waited 2 hours to see the doctor – so I will never go there in the afternoon again and never on a Friday!  Lesson learned.  The rest of my appointments will be early morning and early in the week.

After we finally got in, the technician checked my vision (strangely, the test was conducted with the band-aid contact lens inserted and affecting my vision.)  I did not get the exact measurements, but I had improved three steps beyond last time on the pinhole.

After Dr. Holland came in, he checked the epithelium (see illustration, top section) to see that it had healed over properly so he removed the bandaid contact lens after numbing my eye.  He used tweezers to remove it, and it did not hurt at all.  As soon as it was out, however, I could feel the dryness start.   Unexpected.

Transitions are always tough.  It was not really pain I felt, but a tickle-itch sort of feeling with a mild burn.   Dr. Holland said that the bandaid lens was holding moisture in before, and I would need to supplement that from here on – these lenses have pros and cons.  But cell growth was great.

This solution works for me during the day... I use a gel-tube version of it at night.

Dr. Holland looked me over well with slit lamps with and without florescent die, checked eye pressure and gave me a clean bill of health.   The cornea is clearing, the sutures looked fine, and I was good to go.  I am now to stop using the antibiotic but continue with the steroid and Restasis (tear medicine.)   Now, he said I should expect fluctuations in vision – and that we’re in the long slog of a slowly-healing cornea.

I will be going back in a month, and he may do a topography for the first suture removal, but the decision to remove them will be made on the fly based on the topographies.  I knew this.   He also said that Heather did not need to come with me for those appointments.  I’m glad because it’s a lot of trouble for her to come and wait for me.

I’m to continue wearing my shield at night, and he said sunglasses during the day.   This “wound” is still fragile and I need to take care of it.

We had Buffalo Wild Wings and headed home.  I got very dry on the ride and wished I had brought lubricant.  Once home, I added Systane and it helped a lot.   As I write this, the irritation seems to be fading after a Tylenol

The journey continues…

Click kitten to see my eye on Day 8 - with bandage lens removed. You can see sutures more clearly.

Postscript: 3/19/11.    Eye really feels raw today.  Hoping this is temporary.   Last night I used a gel-type lubricant before bed and that worked really well.   Steroid drops definitely have a burn now when they go in.   These are some things to expect I guess.

 
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Posted by on March 18, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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Back to Work!

Short diary entry – I’m back to work (5 hours today) and even bike commuted.  The weather was glorious.  

The itchiness vanished as mysteriously as it came and I feel SO much better.  The redness in my eye is almost gone already.   I’ll post an update after my follow up with Dr. Holland tomorrow afternoon.   Thanks to everyone for the nice notes and well-wishes.

And while my eye looks totally normal now, I’ll still hide it behind the kitten.   Now that redness is gone, you can see the bandage contact lens clearly.

Click kitten to see my healing eye on Day 8

 
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Posted by on March 17, 2011 in Diary Entries, Recovery, Surgery-Story

 

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Corneal Transplant – 1 Week On

Night Driving Has Improved - I can now see everything much more clearly.

The big news here is ITCHINESS.   I am not talking mosquito bite-level, but poison-ivy level.   It’s distracting and keeping me awake.  Benadryl did not help it… I’ve got high hopes that Zyrtec will.   I have decided to wear my glasses in order to remind myself not to rub the eye.  At night, I’m still wearing the protective patch.  The doctor says itch is a normal symptom, and will look at it during my appointment this Friday – so long as I don’t have any RSVP (rejection) symptoms.

For those unfamiliar, these are the RSVP symptoms that require you to immediately go to your doctor about potential rejection after initial healing period.  Have your Dr. explain them.

  • Redness that gets worse  (eyes will be red after surgery and should slowly clear, but if they suddenly go red again, take action.)
  • Sensitivity to light suddenly (again, immediately after surgery you will be sensitive to light, but this is an increase later.)
  • Vision (foggy or cloudy, or “curtain” effect)
  • Pain increase (aside from small, normal twinges that everyone has.)

Since I don’t have these symptoms…I have a hunch my itch related to this (wretched) 18mm bandage contact lens and/or dryness.   Friday I have my follow up, and am hoping that this lens will be removed for good.

A few random facts I’ve picked up others might benefit from

  • I also learned that you’re supposed to allow 5 minutes between antibiotic drops and steroid drops, but this is not on the post-op sheet.   Also, one of the staff at Dr. Holland’s office said the drops can be done immediately after one another (wrong.)   I’m going to suggest that Dr. Holland’s staff update this info for future patients.
  • Eye pressure increases often include nausea.
  • Rinsing the eye with preservative-free saline (Unisol-4) feels great.  I lay back on a towel and just flow it in while blinking.

The last thing is that my night driving is transformed.  The dark mornings due to Daylight Savings Time meant that I drove my daughter to school yesterday in the near-darkness.  It was great to be able to drive without huge luminescent blobs in my field of vision.

I found a nice PDF handbook for patients about corneal transplant surgery at University of Michigan’s site.

 
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Posted by on March 16, 2011 in Diary Entries, Recovery, Surgery-Story

 

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DALK Transplant – A photo of my healing eye

There are some who would rather not see healing eye photos, but still want to read the blog, so I have placed the day-5-healing-eye photo behind this cute fuzzy kitten.

The photo shows my eye, and the medical contact lens on it, still red from the surgery.  Compared to a perfect eye it looks rough, but it is healing and getting better daily!

Click kitten to see my healing eye on Day 5

Key to photo:

1) Waviness… it appears that the front of my eye is all wavy, but it is not.  This is a result of the “band-aid” contact lens.  It’s annoying because it affects my vision, but important as it’s aiding the healing of my epithelium.

2) Beautiful little sutures.  1/20th the size of human hair.   I do not have a continuous stitch.

3) The edge of the bandage contact lens – very hard to see.   This is a soft lens around the size of a quarter dollar.

 
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Posted by on March 14, 2011 in Interesting Stuff, Recovery, Surgery-Story

 

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DALK Corneal Surgery – Four Days On

Had I planned better, I would have worn this home from surgery and enjoyed children's reaction.

I continue to recover from my DALK corneal transplant/graft procedure on March 9th, and thought I’d bring my (growing) audience up to date on some highlights.  My wife has been a trooper in helping me with things over the last few days, including a bit of grumpiness and anxiety.

Positives:

  • Eyelid swelling reduced.
  • Eye redness reduced.
  • Milky-white vision is gone.
  • Pain levels reduced – Tylenol helps with a mild burn in the morning.  I am surprised how quickly pain has dropped.
  • The overnight discomfort is near zero.  This is a huge improvement for me. In the past, my gigantic cone would get dry and raw overnight.  I used to have to lubricate every hour or so and the pain would wake me many times per night.  For the last two nights, I’ve slept like a baby without any drugs.
  • No post-7:00 pm pain that I had with scleral lenses.
  • Foreign object sensation with sutures roughly the same as a RGP lens.

Annoyances/Negatives:

  • ITCH!!! The areas around my eyelid and eye socket where the injections were given (I was asleep) became very itchy for a day or so.

    Alas, I ended up with this rather more boring version. I just need a flintlock pistol for me belt now.

    If this happens to you don’t forget you cannot rub your eye. Put your shield on and occupy your mind.   It took Benadryl and it helped a bit.

  • An annoyance is this “bandage contact lens” I was given.  It’s purpose is to encourage healing of the epithelium and improve comfort while the nerve endings are exposed.  It’s the size of a quarter-dollar and does not fit well and makes my vision “wavy” – like looking through a wine glass.  If I turn my head slightly, I see bits and pieces of what’s to come.  This morning, from across the room, I caught a glimpse between the contact lens waviness of my iPhone clock – and it was as if I had 20/20 vision for a moment.   Last night, I glanced at the stars and could see that shortly, I’ll be able to enjoy them again.  This should come out at my next Dr. visit.
  • Light sensitivity.  My doctors said that this was quite normal.  We’ve had beautiful sunny weather in Kentucky and I’ve needed to remain in the shadows.  A dark-black patch (available at your local pharmacy) has been tremendously helpful.  I recommend those having surgery buy one.   Dark sunglasses not enough for me.
  • Steroid and antibiotic drops have a mild, temporary burn – but these are critical to recovery.
  • I caught myself drifting off to sleep once without my shield.   Must not!

My activities have been slowly increasing – I went out to breakfast with my wife and eldest daughter yesterday.  Enjoyed it, but had to wear my dark-black patch to avoid the brightness.   I took my bike for a short spin in the neighborhood on the widest lanes.  Dozens of neighbors out enjoying the Spring day.  I did some minor repairs around the house and tried to help with regular household chores (avoiding those requiring lifting or extensive bending.)

I will check in again in a few days.  So pleased to get the encouraging messages, thanks to all.

 
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Posted by on March 13, 2011 in Diary Entries, Recovery, Surgery-Story

 

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A Roller Coaster Ride – But Improving

My pirate patch

My pirate patch

Well yesterday and last night have been rough. My 20/50 pinhole eyechart performance was encouraging, but now the vision is all milky again and the swelling itches worse than anything. Took benadryl to sleep.

Naturally, I worry about rejection, but I only have the milky vision this morning, which is only one symptom. Not the intense pain, extreme light sensitivity, or mayor redness which are also hallmarks of rejection. Also, Dr Holland has told me rejection with compliant patients is very rare. Still, I’m a worrier.

The culprit may be this “bandage” contact lens, which is bunching up on the front if my eye. Anyway, as I write this, waiting in call back from Dr Holland’s office.

Cont…

Dr. Holland’s office seems to think it’s the bandage contacts lens that’s accumulating debris underneath that causing the fogginess.  Re-assured.   Wearing my pirate patch today.

 
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Posted by on March 11, 2011 in Diary Entries, Recovery, Surgery-Story

 

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