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Category Archives: Dr. Visits

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.

 
 

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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DALK Checkup – A Few New Nuggets of Info

Lexington Farmer's Market

Well, today was a routine checkup.  Topography, pressure check, eye test.  Pretty much the same as the last time.  Dr. Holland removed two sutures as we continue “suture roulette.”   The graft looks great, and we’re right “on track.”

I did learn a couple of things today:

  • Peak rejection time is 8 months out from surgery.   This is for PK or DALK.  I thought it would be earlier.  This means that I must be extra diligent for RSVP symptoms between now and early next year.
  • The first sign of rejection will be redness and light sensitivity, not pain.   You should never wait for the pain if redness and pain are present.
  • When Restasis is part of your post-op drops routine, you should usually use it last.   So, for me, it’s Steroids, Pressure Med, then Restasis.
  • He suggested that I might go ahead and use Restasis in my right eye if allergies get bad again.  I think I’m through the worst of Fall allergies, however.
That’s it.
Learn more:
Oh, I really do appreciate all the messages I get about how much people are enjoying the blog.  Thanks much.
 
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Posted by on September 29, 2011 in Dr. Visits, Surgery-Story

 

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5-month DALK Follow Up – 20/30 Corrected Vision – 5 sutures out!

Had a very good 5-month visit today where 5 sutures were removed.  We’re playing “suture roulette” now, chasing the astigmatism around my cornea.

My astigmatism went from 9 diopters to 4 diopters, which is excellent.  I’m now seeing 20/30 corrected!   The graft is also healing very well.  My steroidal dose was cut in half and my eye pressure is now stable/managed.

For the first time in 10+ years, when they adjusted the settings on the eye testing optics, I reached a 20/30 level of vision.  It used to be a pure blur.  They used to flip the lenses around and I’d say “same, same, same”…it never got better or worse.  But now, it’s like it should be.

Dr. Holland said if I was in a hurry, I could possibly get fit for contacts, but I’m going to wait and let the graft heal as long as possible.

It couldn’t have been a better visit.    Back in 8 weeks.

Roulette Wheel Photo by Photo: Heather Rai

 
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Posted by on August 5, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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Managing Intraocular Eye Pressure Issues with my Corneal Transplant (and… 2 more sutures out!)

Topography - to map the surface of the cornea and guide suture removal

Well, I just returned from anther follow up with Dr. Holland post-corneal transplant.  The graft and optic nerve look good, but my eye pressure is still too high – a condition known as “steroid-induced intraocular pressure.”  I’m among a small number (8%) of people who seem to have steady, ongoing eye pressure rises with use of steroids.

We’ve adjusted the type of steroids I’m using, and I’ll be taking a drop to reduce eye pressure as well (the drop is normally used for Glaucoma patients.)   I was also relieved to learn that there were no other reasons my eye pressure was rising (such as tissue or structural complications from surgery.)   Apparently that can happen with full-thickness graft, though rare.  I will be happy when the pressure is moderated – as I don’t like the sound of Glaucoma one bit!   What I think is going on is that I will be using a tiny amount of steroids – far less than most people.   This means I must be alert for any irritation symptoms.

Vision was stable, not that much better.  They claimed astigmatism was down, but I’m not seeing it.  I worked hard to see eye chart numbers.   I wish I’d brought my glasses so they could have evaluated those.  I think it will show I can see pretty damn good through them (despite the old prescription.)

But in terms of graft recovery, things looked good enough to remove a couple more sutures.   This time, the removals had a bit more of a pinch and I was slightly sore afterwards.   Tylenol and back to work.  Next time I might ask them to delay the numbing drops until right before the process itself.   There is this unpredictable delay between numbing drops and when Dr. Holland actually does the removal.   Last time, it didn’t hurt at all.    This is similar to how it went during surgery – my pain meds started wearing off before the procedure was done.  Ouch!

One Niggle… I’m consistently impressed by the Cincinnati Eye Institute Staff, but sure wish they’d dump the blaring TV’s in the waiting room.   It’s not just them, it’s everywhere.  Doesn’t anyone else like to pull out a book to read anymore?

 
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Posted by on July 1, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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Post-DALK Corneal Transplant Visit – 2.5 Month Follow-Up – The First Sutures Removed

Corneal Topography - GraftReporting in after my 2.5 month follow up visit with Dr. Holland at Cincinnati Eye Institute.

During this visit I had usual vision checks, numbing drops,  eye pressure check and topography taken of my grafted cornea.  The eye pressure was a bit high, so I’m cutting back on steroids to a lower frequency.  The topography was successful (first successful one I’ve had since around 2003, my cone was just too steep.)  I tested to 20/60 with pinhole (which reduces effect of astigmatism.)

Corneal Roulette – Suture Removal to Adjust for Astigmatism, Tension

Dr. Holland identified some “tight” and “loose” areas on the sutures via the topography.  He then showed me where he’d be removing sutures.   I really like how Dr. Holland stops to let the patient view the diagnostic tactics.   I have 24 stitches, and it’s impossible to keep them all at the same tension.  Also, the cornea heals at different rates, meaning you might get tension in one area and “slack” in another.

Before the suture removal, the assistant gave me numbing drops and antibiotics.  Then they gave me four more numbing drops, the comment being “you want your eye to be nicely numbed for this part.”   Yikes..   Anyway, the anxiety was for nothing.   I rested my chin on the rest and the assistant pulled open my eye gently with a swab.  Dr. Holland viewed through the microscope and in literally 10-12 seconds, snipped two strategically placed sutures, almost before I realized it.  He then used tweezers to pull out the microscopic threads and before I knew it this was over.  He showed me the sutures – they are like butterfly eyelashes (as my daughter used to say) truly tiny.   Then, antibiotic drops were used (and will be used for a few days) since the suture leaves behind an entry point for potential bacteria.

So, the removal of the sutures was 100% pain free.

Interestingly Dr. Holland told me that if we stabilize the astigmatism, we’d stop taking sutures out – leaving them in place for years.    This would promote a very solid wound healing process.   Some patients have sutures out more quickly based on astigmatism situations.

Droopy Eyelid after Corneal Transplant

After surgery, as my swelling went down, my wife and others noticed that my left eyelid was a bit droopy – a bit more closed than it should be.  Dr. Holland explained that this is probably due to the spreader which was used during the operation which caused a contusion of the muscle.  For most people, it will gradually recover within a year.  If not, there is a simple procedure to adjust it.   No matter what, he said you shouldn’t do anything until a year had passed.   He said the bright side was that it provided slightly more protection to the eye.

Restasis is an Anti-Rejection Drug – News to Me

I think that I know quite a bit about corneas, DALK, etc, but today proved I have a long way to go.  I thought I was taking Restasis for tear production, but actually it was to prevent rejection.  Mark that down in your note book.  Dr. Holland also told me that Restasis was good for combating allergies and is in FDA trials for that indication!   Okay.. bottom line, use the Restasis whether or not your eyes are moist.   Dr. Holland said that it was a steroid-sparing allergy drop.   They’ve used it for hay fever conjunctivitis for a long time.

Eye Pressure Still a bit High

Dr. Holland told me that 8% of patients react to topical steroids, such as durasol, were prednisolone  was a bit weaker and caused less pressure.  It’s only a problem while I’m on steroids, which, for DALK, would taper steroids over a year or so.    I was slightly concerned about what effect higher pressure might have on my eye.  Dr. Holland explain that the only thing that would be a concern was the optic nerve – and mine was just fine and there was nothing to worry about.   Postscript: eye pressure continues to rise, new drops started.

Astigmatism after DALK Surgery

How much astigmatism, and how it will progress during post-op recover, is highly variable.   Some patients have high astigmatism until sutures are removed, while others have low astigmatism until they’re removed and suddenly have a lot.  It’s all normal, and we just have to wait and see where it will go.  If there is a lot of astigmatism after all sutures are removed, we will discuss PRK with a laser to fix it.  For me, I’m minimally nearsighted right now, and will likely remain so for ever.   My corrected vision is 20/60 at this moment.   He said another patient at his office recovering from DALK was 20/25.  Nice.

 
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Posted by on May 26, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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