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Tag Archives: doctor’s answers

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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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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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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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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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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Keratoconus and Eye Rubbing – Which came First?

Scott Clark on Motorcycle

Scott out making his eyes itch, among other things.

The idea that Keratoconus is caused by eye rubbing has been around a while.  I’ve talked with 5-6 corneal surgeons and they’ve had differing opinions on it.   There was consensus that one should be more safe than sorry and advise kids to avoid hard eye rubbing – and to treat the underlying condition.   My daughter’s itchy eyes are treated with Patenol, and I advise my kids to avoid doing it.  I asked them to report it to me when they have itchy eyes and I guaranteed to help them get rid of the symptom.  When I was a kid, I rode motorcycles a lot.  In the dust, dirt, mud, fields of corn, fields of grain, fields of dreams.  But I don’t recall rubbing my eye that much.. but why would I?

“For example, a case control study of 120 subjects with KC involved assessment of potential risk factors, including atopy, family history, eye rubbing, and contact lens wear. In the univariate analysis, there were associations between KC and atopy, family history, and eye rubbing. However, in the multivariate analysis, only eye rubbing was still a significant predictor of KC.” – Charles W. McMonnies, M.Sc., University of New South Wales, Kensington, Australia  (see more)

Here are some other articles/citations on the issue:

This quote from one physicians’ advice puts it in plain English:

Keratoconus has been associated with eye rubbing and eye allergies. Don’t rub your eyes!!! It is believed that eye rubbing can help to distort and thin the corneal surface. To help you with not rubbing your eyes you can use eye drops that lessen the symptoms of eye allergies. Some of these are available over the counter and some need to be prescribed. A good over the counter anti-histamine eye drop is “Zaditor”. Cool compresses help. There is also some evidence that using cooled tea bags and even cucumber slices help to calm the symptoms of eye itching.  – Dr. Jon Vogel

I may extend the list of links above if I find anymore.

Tomorrow:  My pre-surgery physical.

 
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Posted by on February 22, 2011 in Diary Entries, Interesting Stuff

 

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