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Category Archives: Dr. Visits

My DALK graft checkup – Corrected to 20/15 and Next Appt in 1-year

I just visited Dr. Holland again for a checkup.  I had a topography taken and the staff found that I was correctable to 20/15… yes… 15.   Dr. Holland said that cases like mine put to rest that vision cannot be as sharp for DALK patients.   I wore my glasses to this appointment, and corrected to 20/20 with those.

My graft is quiet and my eye pressure and corneal thickness are fine.  Dr. Holland reminded me of what to look for – light sensitivity and redness in the left eye only.  I watch it like a hawk.  He said I’m out of the major rejection period, but to always assume rejection when symptoms emerge “until proven otherwise.”

I’m to keep using Restasis 2x per day (indefinitely) … I learn a bit more each visit about how beneficial these drops are to preventing rejection.  Expensive but worth it, and better than steroids for someone like me who responds to them with increased eye pressure.

No more appointments for 1 year unless needed.

orbscan-1-4-13

 
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Posted by on January 5, 2014 in Diary Entries, Dr. Visits, Recovery

 

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Final 4 Sutures Removed

This morning I went back to Cincinnati Eye Institute and met with Dr. Holland and had the usual run through of tests. I was there 1.5 months earlier than planned because a month ago I had a suture breakage and Dr. Holland said if we start having issues with sutures that I should come see him.

The broken suture was no fun, and I have to travel some on business – was worried that would happen in an airport or in front of 200 people.

So today, he cut the last four from my graft.  There are now no mechanical connections between my body and the donor’s cornea.  That made me anxious for some reason, but I was reassured that it would be fine (unless I got boxed in the eye!)   We tested my eye pressure, vision and did a topography.  All good.

Time to remove the sutures…

dalk-cross-section

The normal drops for numbing and within 5 minutes he’d removed them.   We talked again about PRK surgery in 5-6 months and I was on my way.

Ow.

After the numbing drops began to wear off, I took a couple of Tylenol.  But it was pretty painful.  The longer sutures are in, the more they seem to hurt after removal and numbing meds wear off.

Ow. Ow. 

By 4-5 pm I was very uncomfortable, and took 1/2 of a stronger pain pill which helped.  Also added some Systane to my eye – because the pain is likely caused by the inner eyelid rubbing on the freshly cut areas of my eye.

My plan is to medicate myself liberally tonight and hope that things are better in the morning.

Our PRK discussion was about trying to get my left eye free from the need for any contacts at all.  I asked about risks and Dr. Holland made the point that the risks for PRK are about the same as long term contact lens use (infections.)  So I am strongly considering it, despite the out-of-pocket costs and another procedure on the eye.  We will discuss in 4 months.

Follow up:  2 days later.

Pain is gone and only a residual dryness remains.  I have been doing my antibiotics.  Went metal detecting Saturday and Mountain Biking Sunday and it was great.  Safety glasses for sure!

 
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Posted by on July 12, 2013 in Dr. Visits, Recovery

 

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Broken Suture on Cornea Transplant Graft – How I Handled It

 

itm_l_1144Had a bit of an issue last night.  After taking out my contacts, my grafted eye started to sting like a really, really bad eyelash.  I immediately knew what it was – a suture had broken during the day.  I still have four sutures that Dr. Holland had wanted me to leave in for as long as possible.  No panic.  But time to put the plan into action.

The sensation was a sting, worse than an eyelash in my eye.  I looked at my eye carefully in mirror under magnification, and I could see a tiny little spot where the suture had been moving around.  In the center, a tiny, tiny little suture sticking straight out.   I noticed it after contact removal because my contact was acting like a bandage lens preventing the little suture from moving around.

At a previous appointment, I had asked Dr. Holland what to do if this happened, so when it did, I tried not to freak out.  I went ahead and put a drop of Vigamox (antibiotic) in before heading to bed to keep bacteria from growing in the micro-wound – with a plan to call in the morning.

Dr. Holland had previously told me that I didn’t need to drive to his office (90 minutes away) if this happened, but to just go to a local surgeon in Lexington.  I contacted Dr. Koffler’s office near my house and they had me in at 8:45, and the problem suture was out (or part of it) by 10 AM.

But the suture didn’t come out cleanly.  As you may remember from a previous post, the cornea is getting stronger all the time, and the sutures are getting pretty cemented in and losing some of their strength.  When the Dr. grabbed the eroded suture to pull it out, it broke into two pieces at the knot, and only the protruding section came out on his tweezers.  He tried to get the other one, but it was “scarred in” and he thought it better to leave it there rather than cause too many scratches on the graft.  He guessed that it would never be an issue.  Fine by me.  It would not be painful because it was under the skin.  I’ll let Dr. Holland look at it when I’m up there next.

I’m on a 4×4 regimen of Vigamox and have to leave my contact off for 48 hours, but I think all is okay.  Once this is settled, I’ll call Dr. Holland and see if he’d like to take out the rest of the sutures (so they don’t give me trouble during a business trip or otherwise inconvenient time.)

So… inconvenient, but no panic.  Rather straightforward resolution.  On with the day.

Here is an illustration of what happened to the best of my ability… the (A) is the protruding suture that was getting moved around and where things hurt.  The black dots are the knots.

graft-broken-suture

 
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Posted by on May 22, 2013 in Dr. Visits, Recovery

 

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A Boring Two Year Checkup (Boring is Good!)

Well, had my two year checkup with Dr. Holland and it was a boring visit.  No changes, no sutures out.  Boring is GOOD.

He says that we will leave the sutures in until they cause issues, and eventually one will break.  I’ll just go to a local surgeon to have them removed.  Here’s a boring image of my topography.

Everything feels fine – still using Restasis for dryness and as an anti-inflammatory –  It’s almost allergy season, so I will start my daily Zyrtec soon.

Dr. Holland re-iterated that my graft is looking good and should last the rest of my life.

2-year-topography

 
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Posted by on April 2, 2013 in Dr. Visits

 

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Graft Looks Great – 2 More Sutures Out (and they were stubborn.)

Well, 4 months elapsed since my last visit to Dr. Holland, so I had an appointment today.  I had the usual check ups and topology.  Their office was a *zoo* … I waited 2 hours.  Thank goodness their office has Wi-Fi and I was able to do some email and watch a bit of YouTube.  Not an empty seat in the waiting rooms – and I had asked for “first appointment of the day.”

My eye pressure was 18, totally normal.  The graft was crystal clear.  No problems.  I complained about my dry eye at night and he suggested I change to a gel based lubricant and gave me some samples.  I’ve used them before and not liked their goopiness.

The topology (right) showed that it was time to remove two more sutures, so I was numbed up and Dr. Holland started the process.  It seemed to take longer than usual to cut and pull them out.  I was stone-still during this process.  Anyway, after the numbing drops wore off, it was pretty sore – yowch!  The sutures seemed to be a bit stubborn.  I think that the longer they’re in, the more they integrate into the tissue of your eye.  I took some Tylenol and started my weekend a bit early

Anyway, the usual Vigamox antibiotic dose for 3 days and go back in 4 months.

Now I will make an appointment to get fit for contacts to match my new Rx (suture removal changed my astigmatism levels.)

postscript:  Eye was completely normal the next day.  No discomfort at all. And I think my vision has improved a bit, especially with my glasses.

 
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Posted by on November 16, 2012 in Dr. Visits, Recovery

 

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DALK Transplant – Stellar Follow Up + New Soft Lens Trial

photo: Logan Ingalls

Well, it’s been a good week for my DALK recovery.  I went back to Dr. Holland for my graft checkup and he said it was perfect.  I also corrected to 20/20 on their refraction gear.  I had already ordered a new, special soft contact (see last post) and was not able to take it with me to Dr. Holland.  He wasn’t bothered by that and said that if the soft lens worked for me, it would be fine for my eye.

The downside to the soft lens (at least the first one I tried) is it corrected me only slightly better than 20/30.  This means there is room for improvement.  But the comfort is … amazing!   The fitter (Tamra at Dr. Koffler’s office here in Lexington) seems to think that I should wear it for a week and then we may want to correct the power to hit near 20/20.

Other questions answered:

  • Sutures:  We’ll take them out if they degrade.  Otherwise, he said, leave them in for now.
  • Graft Fragility:  I had lots of anxiety about the graft’s fragility, but Dr. Holland told me to quit worrying.  It would take a severe trauma to disturb the graft now that it’s healed up.
  • Rejection Period:  I’m exiting the prime rejection period for DALK.
  • Glasses:  Dr. Holland said to go ahead and make the lenses for glasses.
  • PRK/Lasik is still an option if we cannot make contacts work.   Insurance won’t pay for that in KY (or OH.)
  • If we run into suture issues (e.g. one breaks) we will remove them all at once.
  • He said it was right to stop wearing the RGPs if they were hurting.  He said I should be pain free and use whatever gives that to me.

Exciting!

 
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Posted by on June 8, 2012 in Dr. Visits, Recovery, Surgery-Story

 

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Contact Lens after Corneal Transplant – Trying a Mini-Scleral

Well, after a fair bit of anxiety and dread, I found my visit to Koffler Vision Group* for the fitting of a new mini-scleral RGP contact lens on my grafted eye to be quite uneventful.  We tried several diameters and shapes until one felt, well, like it wasn’t there.  (*My choice for contact fitting in Lexington.  I’m still Dr. Holland’s patient.  I would link to their site but it is not great and crashed my browser twice.  I will link to their Google Place page though)

Turns out the one with most comfort was a mini-scleral.

I hadn’t considered mini-scleral for my grafted eye, but it makes sense.  It forms a “helmet” over the graft and rests well outside my cornea.  It keeps the corneal hydrated and provides good vision.  I think I had put mini-sclerals out of my head after my less-than-stellar experience with them before my graft.  But that was not due to the lens, it was due to the cone and abrasiveness.

Anyway, I have my lens ordered and will post again when I get it in.  As usual, the Koffler staff were terrific.  By the way, Dr. Koffler was my second choice for my graft – but I just clicked better with Dr. Holland’s attitude about DALK options.  I feel confident either would do a great job, especially on a PK or other surgery.  I did apologize for being such a grump during my last visit to them 2 years ago (I was frustrated with trying to find a contact lens with a steep cone.)

Oh yes, they did a new topography.  Said it was “beautiful.”

 
 

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New – DALK Transplant Chronology

Quick post to let you know that I just made a new page which covers the chronology from my first Dr. appt to one year after the surgery.  Same posts, but in chronological order.

http://corneanews.com/about-kerataconus/chronology/

 

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11 Month Checkup – Graft Clear, Pressure Down – “Go” for Contact Fitting

Had a good appointment with Dr. Holland today.  Especially amazing was the clarity I got on the vision test.  We went through the usual blur-blur-blur series as the technician flipped lenses and asked “now?”.. “now?”…”now?”   Here we go again… but then, almost startlingly, she flipped a lens and the eye chart snapped into focus.  “Whoa!” I said.  “Ah, we found the sweet spot” she said.  In 15 years I’ve never seen so clearly through that eye and any correction device.  It was almost overwhelming.

Dr. Holland examined the graft and said it was completely clear and that my eye pressure was down.  I’m reducing the pressure medicines to once daily, and staying off the steroids.  I’m reminded that I am at the peak rejection period for my graft (many, including me, thought that the rejection period peaks right after surgery, but it doesn’t.)

I have bad nearsightedness, even with the astigmatism getting resolved, so vision correction will be part of this plan.  It’s time you could get fitted for a RGP lens….   that scares me.  I have this graft which I have been treating like a delicate piece of crystal.. and now I’m to put a lens on it?   I’ll have to get over this.  Will schedule my fitting in the next couple of weeks.   There is still a possbility that I’ll go with PRK if recommended.

No sutures out this time – and the ones in there now may remain a while.

Next Appt, early Spring.

 
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Posted by on January 27, 2012 in Diary Entries, Dr. Visits, Recovery, Vision Improvements

 

Corneal Transplant Surgery – 8-month Follow Up – Steroids to Stop in 6 Weeks.

Post Corneal Transplant Topography 8 monthsToday I went in to Cincinnati Eye Institute for my 8-month follow up with Doctor Edward Holland.   The visit followed the same routine as before – corneal surface scan, vision check, pressure check, doctor chat, and suture removal.

My vision is not changed much – and the topography showed that my astigmatism has shifted axis, and Dr. Holland adjusted his suture removal strategy.  I had two sutures out today, which was quick and painless.   My eye pressure was in the normal range and my optic nerve looked just fine.   He told me not to worry about the eye pressure as long as the optic nerve looked good.

The only big news is that in 6 weeks, I’ll be stopping my steroid drops!  This is a bit early and reflects the fact that my cornea is “crystal clear.”   I’m to watch for inflamation around the graft, but none is expected.

I hate late morning appointments.  I left Lexington at 8:30 and wasn’t back until 2:30.  My next appt is at 7:55 AM.  I’ll probably be back in Lexington by 11:00.

 
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Posted by on November 17, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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