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.