Around 10:30 AM yesterday, we arrived at the St. Elizabeth SurgiCenter for my DALK procedure. After a brief wait I was taken back to the prep area where the nurses to sign papers, took my weight and temperature, and checked my vitals. I was hooked to an automated blood pressure monitor and shortly after, an IV. My wife came back to sit with me while we waited on some other patients who were getting Cataracts removed to go through Dr. Holland’s busy operating room. I asked the nurses if they could add espresso to the IV, but sadly, they couldn’t. (Attn: Starbucks – opportunity?)
Dr. Holland came in and said hi, verified it was my Left Eye we were working on (this is part of their quality control) and then marked it with a pen. I was asked at least 10 times which eye we were working on, which led to my earlier post.
The anesthesiologist visited, described the process for putting me to sleep for a few minutes during which they would be numbing my eye (called a “block”). I was glad to hear I’d be out while needles are around my eye (remember the childhood chant “cross my heart, hope to die, stick a needle in my eye”? I said bring on the loony juice for that, Doc.. He said they’d have me “sleepy” during the procedure but able to respond to questions, etc. He also said that should I feel anxious they can add some more relaxation to the formula. I asked him if I could get a doggy-bag with some of that for occasional home use (I am raising two teenagers, after all.)
Several doctors and nurses visited and asked me many questions, listened to my heart and lungs, and filled out many on-line checklists on the computer terminal. It was more boring than anything.
One of the doctors came in (I wish I’d gathered names) and pleasantly talked to me about my condition – and offered up much reassurance about what I already knew – Dr. Holland was renowned for his abilities in corneal grafting – indicating that the guy in the next room had flown in from Colorado for a transplant.
Surgery
After a while, people gathered and it was time to get sedated (remember the Ramone’s song?). I remember them saying they were ready to start the ….. and that’s it – dial tone. Asleep instantly. I then woke to what felt like a flurry of nurses and my bed was being rolled into the OR, which was a well-lit room with Dr. Holland and his assistant. My left eye was in lockdown mode. Very strange.
Some of the things I remember from the surgery:
- The placement of the trephine on my eye and the sensation of Dr. Holland spinning it -whee. This was cutting a precise circular area of my cornea to a precise depth. Completely painless, but I recall thinking “there’s no turning back now.”
- The big bubble being inflated. This caused my blurry world to go snow white all of a sudden. Very strange.
- The dissection of the cornea – lots of blurry lights and a slow removal of the whiteness. Completely painless.
- Discussions between Dr. Holland and his assistant about a micro perforation of my Descemet’s membrane. *(More on what happened later – Dr. Holland filled me in in the follow up visit.)
- Dr. Holland requesting right and left handed scissors as he cut the outer radius of my cornea free.
- Dr. Holland requesting the donor cornea. This was a special moment that I knew was coming.
- The beginning of suturing. And some short-term pain that the anesthesiologist remedied on the fly.
- The application of a large contact lens – which is meant to reduce discomfort while the epithelium heals.
- Dr. Holland saying – “all done, beautiful job.”
Midway Through the Surgery, A Complication
I learned during my follow up that the surgery took twice as long as usual because of the microperforation of my Descemet’s membrane caused by the scar tissue that severe Keratoconus causes. At this point, many surgeons would have immediately converted to PK and done a full-penetrating graft. Dr. Holland’s skill in dealing with this (>50 DALKs per year) came into play and he was able to specially dissect around the perforation and save my Descemet’s membrane. The implications of this are faster healing time, near zero chance of rejections, and a graft likely to last the rest of my life. All of the work in finding Dr. Holland, the trips to Edgewood, and the homework paid off in those few minutes.
Because of the unexpected extension of the procedure, as suturing began, my anesthesia began to wear off (I’m notoriously resistant to anesthetics, my dentist has to shoot me twice as much as most patients.) I was so sleepy that all I could do was moan – Dr. Holland would apologize to me “Sorry about that.” After a couple of these, the anesthesiologist added more pain medicine to the mix and all was well soon – but not immediately.
It was pretty uncomfortable for a few minutes before that stuff got into my system. It didn’t last long, but I would like to have known some sort of signal other than vague moaning. Later, they said I should have let them know – but I was terrified of moving during surgery and disrupting the precise activity Dr. Holland was doing. So ask your surgical nurses or anesthesiologists what you should do if you feel pain during the procedure. For most people, this would never be an issue. I was just under the knife longer than expected for the drugs administered.
Success!!
Dr. Holland’s words will echo for a while… “All Done, it went beautifully.”
After we were done, I was bandaged with a shield, taken somewhere to rest, and eventually transferred from a bed to a recliner in a room where Heather was waiting. It was nice to see her smile. I told her “they did the DALK successfully, it went well.” or perhaps I said “Led Zeppelin planted some Pansies on our Garage Roof” – hell if I know, I was flying high. I had poor balance and was pretty sore. I lost all track of time.
After missing my morning coffee or any Food for a while, I was also getting a caffeine / food headache. The nurses then offered me possibly the best tasting Coke I’d ever had in my life. They also gave me some medicine for my headache, and then I was led to the men’s room for additional relief. Soon, it was time to say goodbye, and, 3-4 hours after arriving, I was wheeled out to the van and we headed back to Lexington.
Get Ready for Some Discomfort, But It Doesn’t Last
After leaving, things got painful in and around the eye and I would have described it at the 8 out of 10 level for a short while. This should be expected – and you should plan on staying on a comfy couch or bed for the rest of the day. Have help around to bring you what you need. It stands to reason things would hurt: your eye was just stuck, sliced and sewn up. It was manipulated like it had never been. Manipulation includes the clamp that holds it open, tons of surgical instruments, endless poking, and several major injections. I wonder if the pain management could have been better perhaps with narcotics – but the nurses just told me to take Tylenol. Tip: Ask your nurses if you can have something stronger just in case.
But take some comfort. It felt far better after 5-6 hours of rest – and by the next day, the soreness was more irritating than anything. It is worth it and a small price to pay for long-term better vision. Just don’t expect this to be a cake-walk the first day.
My eyes are tired, so this post will end here. Next: My follow up.
Please make sure to read the entire diary and get the full story.
hi great article ,i live in the uk and am due to have a corneal tansplant in the next few months ,can I ask if your scar dissapeared completley ,i have a large white scar ,also i am quite nervous about the whole thing .many thanks rob
Thanks. My scarring was invisible from the outside – Dr. told me it was more like “stretch marks” on the tissue.
While I cannot be sure in your case, generally If you have a corneal transplant, and your scars are on the cornea, then the scarring will be removed with the tissue and replaced by donor tissue. For me, the scarring didn’t reach my Descemet’s membrane, so I was able to have DALK. If the scarring has affected this membrane, a PK will probably be the result. Either surgery is a good solution.
Yes, nervousness is completely normal. We all have anxiety going into something of this magnitude. But the science/art of corneal transplantation is among the most advanced of all – hundreds of thousands have been done with a very high success rate. Drug therapy has developed to fight rejections if they occur. Specialized tools have been refined, refined and refined again. Make sure to locate a very good surgeon (may not be the nearest one, as was the case for me) who has done many grafts per year. Don’t hesitate to ask them hard questions. And when the surgery is completed, remain totally compliant with your medications and instructions. It will be a difficult week after the surgery, but keep thinking about the lifetime of improved vision to come.
oh my… feeling overwhelmed having just discovered your blog. (and reading up through surgery day, so far) I have not yet schedule my cornea transplant, but I saw Dr. Holland 3 wks ago and that was his recommendation for me. I’ve had 3 other cornea specialist say the same thing. I want to let you know that until reading your blog (so far) I was struggling with HOW to choose between Dr. Holland and another Dr. (both from the Cincinnati Eye Institute) I’d also liked. I am now convinced that my ‘gut’ new all along, I just needed alittle nudge! Thank you for being so committed to this blog. I KNOW its going to be very helpful to so many!! (including myself!) Debbie
Hi Scott, I have read your blog thoroughly and just wanted to say thank you for documenting your experience with such detail. I was diagnosed with keratoconus when I was about 12 and have tried everything under the sun to rid myself of it or stop the symptoms. The disease no doubt changed my life. For someone who planned to be a police officer and an MP I was pretty disappointed when the government listed keratoconus as an immediate disqualification for service! But God was good and after school I found a job as an IT Manager fir a medical organization. At any rate, I am now 25 and next Monday (Feb 24th) I will be undergoing the DALK procedure here in NY. Surgery will be performed by Dr. Khalifa at the FLAUM Eye Institute in Rochester.
What did you do about showering? I imagine you had some sort of procedure? How long did you need to carry this out?
You mention a terrible itching sensation in the eye. Is it possible to itch around the eye socket as long as you don’t touch the cornea?
Should I wear the dark black eye patch immediately after surgery or must I wear the giant perforated patch that doesn’t fit well?
Is there any other advice you can give me? I am a little bit anxious about the whole ordeal but that’s to be expected I suppose.
Thanks!
Hi Dave…
Showering was not really an issue that I can recall, but I think I went without it for 2-3 days after surgery opting for a washcloth, soap and water to maintain basic cleanliness. My guess is that the police prohibit KC because of the impairment to vision before surgery, and the relative fragility of the graft after. It seems to me that all of this could be mitigated with safety glasses (not the hardware store type, but the type used by special forces.) If you have a link to something showing that ban, I’d love to read it.
As far as itching, best not to get close. The itching was on and off again, and eventually went away completely. I used benadryl at night which helped.
I followed my Dr. recommendations regarding eye patch, but it was mostly at night… I wore the heavy duty patch for around 5 weeks (or more, I cannot recall, I just got used to it) and then transferred to a sort of “heavy” black patch I found at a drug store. Some are better than others – open the package at the store and look for a bit of durability. It’s essential that you not rub your eye, so it’s worth tolerating this inconvenience at night. Listen to your Dr. recommendations on this, not me.
As I’ve mentioned throughout my blog, anxiety is a normal reaction to this. DALK (and PK) are well practiced and the procedure is really worked out well. I think key is to be a compliant patient with all recommendations after the surgery, and for the years to come. After you’re done, get some high quality safety glasses you can wear anytime you’re doing outdoor work, near toddlers (!), cooking or even cleaning house.
As far as whether you’re out or awake, it’s up to the Dr. I guess. He gave me the option about whether I wanted to go under, but that the surgery was slightly easier if I could “help out” (look up, look to side, etc)… I opted to be a helper. In hindsight, I am glad I was awake. Not exactly sure why – perhaps just intellectual curiosity about what was happening to me. If I were out I’d not have had such an interesting memory of it.
I wish you very best and would welcome news about how it went… And should you feel up to it, a guest post (with a couple of pics) would be welcome on the blog as well.
Hi Scott, thank you for the info. Here is a link to a page that quotes the Army ban: http://usmilitary.about.com/od/joiningthemilitary/a/eyes.htm . It even specifically states keratoconus in the handbook! I was planning on becoming a NYS DEC officer but was told (verbally) that I was ineligible because of my vision issues (keratoconus). I can’t find it in writing anywhere… perhaps the prohibition is at each departments discretion?
Thanks again for the support! I can’t promise I’ll get some pics up, but I’ll report back to let you and your readers know how the procedure went!
I forgot to mention, the Dr. Said he would put me to sleep completely during the surgery. It didn’t sound like you were completely out though. Is this just something that is up to the doctors discretion?
Hi Scott, the surgery itself went well. However the Dr. put a small air bubble behind my layer of tissue in order to sandwich it up to the donor tissue and the air bubble was too big! The pain from the high press was unreal… immediately after the first surgery I was drifting in and out of consciousness and began to vomit. My core temperature was also fluctuating rapidly (sweating like crazy one second then freezing the next). The Dr. took me to an exam room and poked a needle in and removed the bubble and it was immediate relief. Along with a few flashing black vertical lines, this is basically what I saw before he took the air bubble out: http://teedhaze.com/images/public/tv-snow.gif
The next day (Tuesday) the Dr. examined me and said he needed to put the bubble back in immediately. The numbing drops didn’t work at first so the pain was unreal when the needle went in. He apologized and put other types of numbing drops in and they worked. He got the bubble in and it was all over within 5 minutes.
Unfortunately the air bubble he put in disappeared somehow over night. He said the body may have absorbed it too quickly. He also said he has only ever had this happen to one other patient he had out of the hundreds of DALK procedures he has done. So he said he needed to put the bubble in again. I begged him to put me to sleep for the procedure! He agreed to and the next day (Thursday) we went off to the OR.
This time he put a large air bubble in and let it sit for 15 minutes while I was still knocked out. He then released some of the air before allowing me to wake up. To our relief it worked! When I woke up things were pretty stable but then started to go down hill. I had that splitting headache feeling like I did the first time I woke up and I was in extreme pain- 10 out of 10. Then for some reason it miraculously dissapeared and the pain was back down to about 2-3 out of 10 which is normal. Personally, I believe that God performed a miracle at that time.
The next day I came back for the followup visit and the doctor said ‘now THIS looks like a cornea transplant!’ and said the bubble was still there albeit a little smaller, but that the donor tissue and my native tissue had become attached as they were supposed to. He also said he was surprised how quickly my eye was healing. I was very relieved!
It is now day 4 since the surgery and I will be going back to Rochester on Wednesday (3/5) for another followup. At this time I can see better than I could see before the surgery. It is still very blurry but I think that’s normal for only 4 days. I have a very slight headache but I attribute that to the eye drops. My primary concern is the redness of my eye. There is also a strange bubble that you can clearly see in the center of my eye. Any ideas of what that might be? Here are some pictures:
1.5 days after surgery: https://plus.google.com/photos/115402764144655431061/albums/5568528792469280401/5986583760414380098?banner=pwa&authkey=COrV-5m5hOmC4gE&pid=5986583760414380098&oid=115402764144655431061
3 days after surgery:
https://plus.google.com/photos/115402764144655431061/albums/5568528792469280401/5986583763305494386?banner=pwa&authkey=COrV-5m5hOmC4gE&pid=5986583763305494386&oid=115402764144655431061
Sorry to hear you had a rough go of it. The photos remind me of how my eye looked (and eyelid) right after surgery. No doubt about it, it’s a big surgery and it sounds to me like your Dr. has handled complications with skill. I wouldn’t want to guess about the redness/bubble, but just ask your Dr. I used to make a list before every appt (when I was feeling badly, my wife wrote things down for me.) Hang in there!