Outstanding 1 Month Visit – Corneal Transplant Follow Up

I had my one month (and a week) visit to Doctor Holland today and all went very well.   He said my transplant was healing better than most, and my vision continues to improve.  The astigmatism is taking front and center but they said that this will begin to be addressed in my next appointment when a few sutures may be removed.  This is done strategically based on the topology.  Dr. Holland told me this was the reason he uses so many interrupted sutures… it allows for “Suture Roulette” where he can tweak things very precisely while keeping sutures in place to allow healing to continue.

I didn’t get the number, but could see some pretty small letters via pinhole.   Interestingly, I learned that the pinhole is a measure of  “potential” vision or “correctable” vision.  So I have some seriously high hopes!

The only concern was a minor increase in interocular pressure (trend…18 to 20 to 27 mmHg) – both doctors say that this is due to the Durezol steroid (I have been on a high dose) and it was nothing to be alarmed about.  They changed my steroid to Pred Forte – a weaker steroid – to manage this.  I was told that around 8-10% of patients fall into a category “Steroid Responders” – a genetic condition… who have a pressure response to steroids.   I had no inflammation on my eye so the reduction in steroid should not have any downside.  They told me that I was out of the high risk timeframe for “RSVP” type symptoms and that the steroids are there just to prevent any chance of rejection.

I mentioned my itchiness and they said I could take Zyertec for it… but if that didn’t do the trick they’d subscribe an allergy drop.  I don’t like adding variables to the mix if I have a working solution, so don’t plan to ask for the drop unless things get bad.

I was also told I could stop wearing a shield at night if I wanted.

As far as how I feel – It’s great!   I can drive at night and have very, very little pain.  I have no complaints at all and so far I’m very, very glad I had this done.

Back in six weeks!

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7 Replies to “Outstanding 1 Month Visit – Corneal Transplant Follow Up”

  1. Hi Scott
    thanks for your blog. Its a lot of information for me. Im going to undertake DALK this year. My story is slightly different than yours but I also have keratoconus in my eye.
    Ive done a lot of research on the web as I expect that you did. But still I have some unanswered questions. Im going to see specialist next month for first time. I will ask him of course. But perhaps you already know answers, so if you dont mind, may I ask you?
    1) What about long term limitation after dalk? Are there any? I found only information about PK. That the wound is very week and you must be extremly careful with your eye. Then information that the dalk is much more stronger than PK. But how much? Did doctor say you anything about that?
    2) Cosmetic appearance of the eye after it is healed. Will be the circle scare still so much visible as it is after operation? Photos on the net are only eyes in healing process, with sutures.
    Well thats all.

    Wish you the best and please, wish me the same 😀
    And sorry for my english; its not my native language.

    1. Answers (I am not a physician, so these are not medical advice – always confirm my opinions with a trained doctor.)

      1) All corneal grafts require that you over-protect your eye for life.. I do not think there is a greater strength in the wound between DALK and PK as the differences are at the extreme rear of the cornea – the Decement’s layer (remains after DALK, removed after PK). In either case, the wound never heals back as strong as a normal cornea. I wear safety glasses during sport and yardwork, and use care never to rub my eye. I have Spring allergies (which can be bad in Kentucky) so am careful to treat the itch with antihistamines daily to avoid the temptation to rub. It must be a conscious effort forever. By the way … since I was diagnosted with severe Keratoconus years ago, I’ve been over-protecting my “good” eye (knowing that injury to it would render me functionally blind.) So this habit of protecting is not new to me.

      2) Mine is still with sutures, so cannot say. People cannot even see differences with the sutures, however, so I expect the cosmetic impact to be negligible. For me, it’s the least of my Worries!!!

      Good luck to you!

    1. I have also confirmed this on my end, and edited my response below. Quote: “With DALK, there is increased wound strength compared
      with the PK wound, which is subjected to the prolonged
      use of topical corticosteroids to prevent immune
      rejection, and there is decreased risk of cataract progression
      and less compromised local ocular surface immunity.” … from this paper: http://www.assocheratocono.org/public2/documenti/DALK%20alternative%20to%20PK%20AAO%20report%20%28Ophthalmology%202011%29.pdf

  2. Yes. Theres a lot of these medical articles on the net. I spent a lot of time reading them past months. Actually It become my hobby 😀

    Ive found some examples of wound strength after keratoplsaty.
    In PK: eye will be damaged by punch of the fist, hit by ball etc. That means a lot of power. But I found also a report when wound was damaged while removing contact lense from the eye. That isnt much power.

    In DALK: I found only one article. Graft stayed untouched after hit by elbow. Respectively it was in the healing period while sutures still presented. Sutures were ripped off, but graft itself stayed untouched in place. With no effect to the vision. That means it is much stronger.

    This is, of course, information collected by amateur research using net so nothing reliable 😀 And Its almost sure that the wound strength would be different case by case.
    But at least, some information.

    Otherwise, some additional wound strength is achieved white laser assisted operation. It brings mechanical strength if the cut isnt flat http://webeye.ophth.uiowa.edu/eyeforum/cases/case46/Figure%202.jpg . The pressure from inside of the eye holds graft on the place.
    And greater space of the wound plus faster healing (less need of corticosteroids???) should help also.

    And the scar after laser operation is less visible then it seams after manual operation. Just look at this. Its almost perfect. http://webeye.ophth.uiowa.edu/eyeforum/cases/case46/Figure%207.jpg

    Why I care about this things? Because they are last things on which I dont have satisfying answer 🙂 They are not most important to me, of course. But otherwise, if all will go well, these are only things that I can be aware of after healed operation.

    One clinic which I will visit have proper laser. So I will try to get to the laser assisted operation. It brings only advantages (respectively only disadvantage is cost of that procedure… 🙁 )

    I will write report after talk with surgeon, if someone is interested 😀

    1. Yes, that is pretty normal – you’re still early.. My vision is also blurry as expected. It’s better than pre-surgery, however. As sutures are removed, astigmatism should be reduced, improving vision. If this is not completely resolved after a year or so, I will have a PRK laser finish the job.

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