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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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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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Tip for Corneal Suture Removal Antibiotics – Saving a few bucks

When you are in recovery from corneal transplant, your doctor will begin removing sutures – a few at a time each visit (providing everything is going well.)  Each time you leave you’ll be asked to drop antibiotics for 3-4 days several times per day.   A tiny amount, all in all.

The tip I have is this… ask the doctor or assistants if you can have a sample antibiotic (left by drug reps) rather than a prescription.  The samples have just the right number of drops for 4×3 or 3×3 and are meant to be given away for free.  This can save you the cost of the antibiotics and a trip to the drug store.   Even ask them to give you several bottles to be used on the subsequent visit (they have a decent shelf life.)

The doctors can get more, trust me.

This might save you $30-40 per visit.Antibiotics for Corneal Transplant Suture removal

 
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Posted by on November 20, 2011 in Surgery-Story, Tips

 

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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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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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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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