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Category Archives: Recovery

Corneal Transplant Recipient Getting Flu Shot? Ask Your Dr. This Question

2015-09-13 18_26_13-flu shots - Google SearchShould you protect your cornea from flu shot immunization rejection?

If you’re a corneal transplant recipient who gets flu shots, you may want to ask your corneal surgeon if you should use Tobradex (or equivalent) to avoid potential rejection due to the flu vaccine.  My particular instructions involve taking some drops a few day before my flu shot, and then for several times per day for a month afterward.  My doctor also recommended that I continue with Restasis as it provides some measure of rejection prevention.

This is done in an abundance of caution, I think.  But it’s worth a quick call to see if it might reduce your own chances for rejection.

 
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Posted by on September 13, 2015 in Recovery, Tips

 

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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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Little Things: Glasses after Corneal Transplant (That Work!)


oakley

A short post today.  With the sutures coming out slowly over time, it’s always been my choice to put off getting a new eyeglasses prescription.

With lenses being so expensive, and insurance limitations, it hardly made sense to pay for a new left lens every few months as my vision (astigmatism) was altered by the process.  I was already tweaking expensive contacts to follow the “suture roulette”, so I chose to hold off on the glasses.

Well, with all sutures out and a month of stabilization, I’ve finally got new lenses for my Oakley glasses.  It’s amazing to have spectacles that correct nearly as well as my contacts – and liberating.  I can now feel more confident on driving holidays where I might find myself at the wheel longer than my lens wear time allows.  And I can easily drive should a mid-night emergency happen.

Scott Clark

With allergies wreaking havoc on both eyes this Fall, I may choose to wear the glasses more often, allowing me to use eye drop antihistamines anytime I need them, avoiding the drowsiness that comes with their oral equivalent.

I cannot remember when I last had glasses that worked so well – but I’d guess it’s been nearly 15 years.

So, yet another little thing that the DALK surgery has brought me, more than two years later.

 

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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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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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Quick Update: No News is Good News

Hello to everyone. I’ve been getting email asking how things are going so I thought I’d post a quick update and catch everyone up. The site is seeing quite a bit of traffic

First of all, I am still wearing the soft, custom lens on my grafted eye. I’m still very pleased with it. I went ahead and ordered a couple of pair of them which should keep me going until my next appointment with Dr. Holland. If he removes sutures, my prescription is likely to change some – so I don’t want to have expensive lenses I just throw away (these lenses last 3 months.)  My vision is about the same as it was in July.  Not pin-prick-perfect, but very close.   With my right eye working with the grafted one, I have great vision.

I’m so happy with the night driving. We took a trip to Atlanta last week and I did a lot of night driving then. It was wonderful to be able to just drive on and get the trip done while others snoozed in the car.  We were going to dragon*con, and while we were there I noticed that many of the attendees in costume were wearing those weird colored contact lenses.  I shuddered to think about the damage they could do being in there for 18+ hours a day.

My allergies have been a bit of an issue, but nothing like last year. I’m taking daily allergy meds and my eyes don’t get very itchy anymore.  I take a daily Zyrtec as I’ve mentioned before.

I’m still compulsive about protecting my graft and it’s paid off recently. The other day an extension cord in my garage came down and whacked me on my safety glasses covering the grafted eye! Anytime I’m doing yard, garage or basement work, I wear something.  I think it would have hit me in the eye directly!

I don’t have that much news beyond this.

Keep the comments and questions coming – I’m happy to try to answer them.

image by Tjerk Zweers used under creative commons CC:Attribution 2.0 Generic.

 
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Posted by on September 7, 2012 in Diary Entries, Recovery

 

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Tiny Update: Soft Lenses Rock

photo (CC) Kate Ter Haar

My newest set of soft lenses are amazing.  Comfortable (16 hours+) and I can see pretty well.  Not quite as crisp as the RGP, but the comfort trade-off is worth it.  My overall vision is amazing.

I’ve ordered a few of these lenses ($50 per pair) which are custom crafted for my topography.  I’m not wanting to order too many because the shape of my eye will probably change a bit more if sutures come out, etc.

 
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Posted by on July 30, 2012 in Recovery, Vision Improvements

 

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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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Trying Different RGPs – My lens tolerance is only a few hours.

Well, as usual, this is going to take some trial and error!

I have tried three different RGPs (Essilor Perimeter Lens) and cannot tolerate any of them – the mini-scleral was pushing a “grove” into my sclera – apparently my eye was swelling around it?

I can wear them 7-8 hours, but my eye is very sore afterward.    I am now going to be trying a custom-profiled soft lens.  The manufacturer apparently uses my topography to construct them.  I was hoping I could use a soft lens, so we’ll soon know.

Koffler Vision Group is doing a great job.

photo:  Lee J Haywood

 
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Posted by on May 24, 2012 in Diary Entries, Recovery, Vision Improvements

 

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