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Corneal Transplant Grafts and Autumn Allergies

Lexington, KY AllergyWell, I looked at my iPhone Allergy App today and it says 10 out of 12 “Very High” for ragweed pollen – my nemesis.   Lexington is the Allergy Capital of the USA (at least in Spring,) and ragweed is the worst.  I take a daily Zyrtec which helps a lot, but several weeks out of the year it’s overwhelmed by the environment.

One interesting thing I noticed this Fall (my first with a corneal graft) is that my grafted eye doesn’t itch.   My ungrafted eye is itching like crazy.  I’m guessing it’s the nerves on the eye making the difference?  Or something about the surface that is dispersing the allergen?   Whatever, it’s a real blessing.

No matter what, I will always avoid rubbing.  Even though my right eye is past the highest risk for developing Keratoconus (I’m age 45) I still know that my corneas have a genetic weakness somewhere in there.

Everything is going great otherwise.  I’ve had a few headaches and some throbbing on my left eye.  I’m hoping it’s not eye pressure but as of the last visit that was on its way down.  I have another appointment in a couple of weeks.

 
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Posted by on August 26, 2011 in Diary Entries, Surgery-Story

 

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Little Things #3: Ability To Really Get Back into Mountain Biking

Mountain biking in Kentucky is generally called “Cross Country” riding.  The terrain is made up of undulating hills usually 150-200 feet maximum.  A good 10 mile ride will take several hours and offers a tremendous upper and lower body workout.  It’s more like cross country skiing than downhill skiing for lack of a better example.  The reward for a long climb is usually a roller coaster ride through a tunnel of vegetation, airborne some of the time, making split-second decisions on how to manage what’s coming at you.  You’ll encounter wildlife and get away from the city in a very special way.

The wooded trails require depth perception.  Things come at you and you must make a decision, react and adjust your “line”  to overcome it.  Branches can be low, rocks can be loose, and alternative paths through difficult terrain can make the difference between a thrill and a spill.  It’s definitely possible to ride with one bad eye, but you must ride slowly and carefully or choose “open” trails like the fire-roads I rode in CA.   Kentucky has very limited trails compared to most states (go figure) and most are of the wooded variety, so this is great for me.

I’d say ride wherever and however you can, good eyes or not, and adjust your pace and path.  As my surgical eye gets better and better, I crossed a “binocular” threshold where I am comfortable on cross country wooded trails again.  When I stop in the woods to enjoy a babbling creek or to watch a white-tail deer , I’ll say “thank you” again for the priceless gift that my donor gave me.

<photo by trailsource.com used under CC license>

 

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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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Another Appointment Friday

This is a really short update to let everyone know I’m doing fine.  I have another appointment Friday with Dr. Holland when I assume he’ll do another topography and remove more sutures.   I’ll report back then with a usual update.  My only concern is eye pressure, but I’ve been diligent at meds and hope it’s stable.

 
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Posted by on August 2, 2011 in Diary Entries, Recovery, Surgery-Story

 

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NPR Covers Keratoconus

National Public Radio gives Keratoconus some much-needed publicity today in the US.  Sadly, they didn’t mention some of the most important points of the disease, such as DALK vs. PK, advances in contact lenses, or encouragement of organ donation.  Still, it’s great to have such a big increase in awareness.

 
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Posted by on July 11, 2011 in Interesting Stuff

 

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Post-DALK Transplant Topography – Graft

This is what my corneal topography looked like after 2 sutures removed, and led to the removal of two more.

Corneal Topography - Graft

 

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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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Little Things #2: Ability to Use a Bike Mirror

After you have DALK/Corneal Transplant, you start to notice some of life’s little conveniences that were out of reach when your eye was messed up.

So… Little Things #2,  The ability to use a bike mirror…   as a bike commuter, these small glasses-mounted mirrors have always been great.  But with Keratoconus in my left eye, I’d not been able to use it.  Naturally, these only work on the left side (in the USA) as this is where the traffic is.

 

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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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Allergies and Some Discomfort, But Overall Strongly Positive!

Protective lenses for bike commuting

Okay, so I have my next follow up visit in 10 days, but thought I’d post a quick update with a few observations.

First, overall things are great.  I am very pleased with the outcome.   I am able to drive at night without even thinking about it.  We’ve had lots of rain in KY lately, and I’m fine driving at night in the rain.  Amazing.   The vision alternates daily but never gets anywhere close to as bad as it was pre-surgery.

I’ve had some allergies lately, and they seem to be causing some discomfort in the DALK eye.   My daily Zyrtec doesn’t seem to be enough to completely fix the problem.  I have no added redness or vision changes, so I have little concern about it.  I also may have a suture that’s grumpy.    The Restasis makes me itch quite a bit – but I’m forcing myself to use it.   I’m still not mowing grass or doing garden work.  I’ve been paying someone to handle it.

TIP: When you have surgery, ask your Dr. for one of the physician samples of whatever steroid drop you’re using.  It’s nice for carrying around in a purse or briefcase in case you leave the bottle at home.  Yes you will.

So I’ll update again on the 26th or 27th after my visit to Dr. Holland.

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

 

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