Last update 11/03/00
The realization didn't really hit me until the Thursday before my surgery. Sure I knew what the surgery entailed. I knew someone's life had to end so I could see again, but nothing really sunk in until that Thursday morning. As a group of my co-workers were bitching about all their problems at work, that was when it hit me that yes, they can bitch, but at least their not having their corneas harvested so that I can see again. All in all, pretty messed up.
I am fortunate that my parents wanted to come to Ohio and take care of me for at least the first week after surgery. Without them, I'm not sure how I would have made it through the first week. My parents showed up Sunday afternoon from Maryland, and we went out for the proverbial Last Supper.
I really didn't start to get nervous until we reached the hospital Monday morning. After waiting for what seemed to be an eternity in the out patient waiting room, I was escorted back to the pre-op / recovery area to change into a gown and get onto a gurney. The nurse took some more history, took some blood pressure readings and then started a serious of three sets of Toborex (steroid) and I believe an antibiotic. Next came the anesthesiologist to put in my IV. When the IV was in place, the anesthesiologist started pumping a diuretic into the IV. I was told that the diuretic is used to draw water out of the eye to soften the eye for surgery. With the diuretic on board, the nurse put an elastic device around my head, and placed an instrument with a small inflatable bladder over my eye. The bladder was inflated causing some mild discomfort, but no real pain. Although I didn't ask, I believe this device is further used to soften the eye prior to surgery.
When all was ready, the anesthesiologist came back over and explained that I was going to be given a "twilight" anesthesia that would take me under long enough so that they could do a local anesthetic nerve block to the eye. The anesthesiologist told me that with the "twilight" some people don't remember the operation, and some do. I was part of the latter group.
I woke up in the surgery room as they were strapping down my hands (so I couldn't lend a hand to the surgeon mid operation). Many people I have talked to say that they wouldn't have wanted to be awake during the surgery, and prior to the operation, I also thought I wouldn't have wanted to be awake. However, between the heavy sedation, and the fact that I had researched what was going to happen, I actually found the experience to be surreal and fascinating. After tying my hands, they completely draped the right side of my face, and started cleansing the left side of my face. The cleansing stung somewhat as the alcohol and iodine actually went in the eye. Next came a drape over the left side of my face. This one was different from the first, it had a semi-translucent, membrane quality. The drape was then cut directly over the left eye.
The first significant part of the operation I remember is the trephine (cookie cutter device) coming down and cutting the cornea. I believe they cut the cornea straight through, not using the scissors I have seen used in other operations. I remember the donor cornea being put on the eye, and I remember most of the stitching process. At this point I was actually dosing in and out, which is kind of weird sleeping with one eye open. Near the end, I did start to have some pain when they were stitching. I vocalized my pain to the surgeon, and I think he did use some topical anesthesia, but it had little effect. The one thing that did hurt immensely was the injection of antibiotics directly into the eye at the end of the operation. I didn't actually feel the needle going in, but there was an intense burning sensation that lasted approximately 20 minutes. The last things I remember before they wheeled me into the recovery area was having a discussion with the operating staff about Star Wars Episode I, having a metal patch put over my left eye, and my right eye being undraped.
My parents rejoined me in the recovery room, and I was able to put my right contact in so I could see. I was fed crackers and water, given Tylenol 3 for pain, and allowed to get up and use the restroom with assistance. Within two hours of the operation ending, they had pulled out the IV, allowed me to get dressed, and discharged me from the hospital.
The first afternoon and evening was probably the worst. The burning sensation from the antibiotic shot was gone, but I had this constant scratching feeling. It felt much like a RGP that had dislodged off the center of my cornea, but still in my eye. Closing my eyes seemed to be the best way to lessen the pain; thus, I slept a lot. My sleep was interrupted just about every hour with a need to use the bathroom. The diuretic was still on board and pumping out the fluids.
Tuesday 4/11
Had an 8 a.m. doctor appointment. The technician took off the metal patch and cleaned up my eye. On the eye chart I could see the "E" at the top of the chart, and some of the letters on the second line. With the pinhole device, I could read three lines down. Both encouraging at disappointing at the same time. Encouraging because the vision is already better than my left eye was uncorrected prior to surgery. Disappointing because I still am not seeing very well.
My doctor inspected the eye and found everything about as he expected. He told me that the scratchiness I was feeling was my eyelid going over the stitches, and until the epidillium (sp?) (outer layer of cells on the eye) healed over, it would continue to feel scratchy. My doctor put me on a Pred Forte (steroid) 4x/day, Polytrim (antibiotic) 4x/day, Acular (anti-inflammatory) 2x/day, and told me to continue my Patanol (for allergies) 2x/day. I was told to soft patch the eye during the day through Friday, and wear a hard patch at night. I was given an instruction sheet letting me know what I could and couldn't do. No bending at the waist, no lifting anything heavier the 10 lbs., keep water out of the eye, sleep on my back or side that wasn't operated on while using the hard patch, etc. The instruction sheet was actually for cataract patients, but I was told it all applies for corneal transplants too. I am to go back to the doctor's in one week.
Wednesday 4/12
Having problems with my left eye feeling extremely scratchy. The only way I seem to have any comfort is with both eyes closed, hence I am not wearing my right contact and I am sleeping all the time. Thank god my parents are here or else I'd probably starve.
Saturday 4/15
Today is the first day I am going without a patch during the day. The eye is feeling less scratchy and I am able to tolerate keeping my eyes open. I have found that I am extremely light sensitive, especially in the morning. While my parents are watching the morning news, I'm wearing sunglasses indoors. I am also finding myself constantly closing blinds and turning off lights.
Tuesday 4/18
Had my one-week post-op visit today. Thankfully my dad is still here to drive me the 45 minutes to Cleveland. My mother had to leave Sunday because of work commitments, but she wanted my dad to stay and take me to my appointment. If he hadn't been here I would have been busing it to Cleveland. The vision is about the same as last week. The cornea is clear and there are no signs of rejection, but the epidillium hasn't yet healed over the stitches. The doctor suspects that my allergies are delaying the healing process. The doctor slightly altered my medication to Pred Forte 3x/day, Polytrim 3x/day, Patanol 2x/day, and no more Acular. I have an appointment to go back and see him in one week.
The eye is feeling a little better every day. The area where I seem to have the hardest time is at the computer. I don't know whether it is the brightness of the screen (yes I have tried adjusting it) or the eye trying to focus or a combination of both. I am still napping most afternoons.
Wednesday 4/19
My dad left yesterday afternoon, so I decided to try out my driving skills today. Took in a movie that was playing in a theater a couple of miles down the road. Thankfully the day was overcast so I was fine with my hat and sunglasses. Having had periods of time where I couldn't wear a contact in one eye or the other, I didn't have too much trouble driving. Of course this was also a road I was very familiar with, and my right eye is my more dominant eye anyway.
Tuesday 4/25
Had my two-week post-op visit today. The drive was brutal from a light sensitivity standpoint. Today was a beautiful day, and I thought I would be alright driving with just my dark sunglasses and hat, but I was wrong. By the time I reached the outskirts of Cleveland, I was squinting and swearing at myself for not bring my patch for my left eye. Interestingly, the drive home wasn't anywhere as bad, possibly because I still seem to be most light sensitive first thing in the morning.
The technician measured my eyesight and it was still the same. The doctor examined my eye and told me that the epidillium has finally healed over, but my eye seems to be somewhat irritated. He thinks the irritation is some of my eye's secretions rubbing against the inside of my eyelid. The doctor did remove a sticky secretion from the sclera (white part of the eye). The removal left me teary eyed and not looking forward to the adjustment of stitches. As for the cornea, it is still clear and shows no signs of rejection. My new regimen consists of Pred Forte back up to 4x/day, Muro 128 (a re-wetting drop that draws moisture out of the cornea) 4x/day, Polytrim 2x/day, Doxycycline (oral antibiotic) 2x/day, and eyewashes at bedtime with baby shampoo followed by Ilotycin (topical antibiotic ointment). I am to go back to the doctor's office in two weeks.
Saturday 4/30
Well my Blockbuster card is just about worn out, so I guess that means its time to go back to work. I work in a printing plant, and did not want to return until the epidillium healed over because of some of the chemical vapors. Also, most of my job is in front of a computer, and that is still the hardest thing for me to do. Fortunately, I can now sit at the computer for at least a couple of hours. I have also taken a set of my sunglasses and removed the right lens. When my left eye starts to ache, this arrangement gives me some more computer time.
Weds 5/3
It has been a hectic and awful week. I really put my transplant to the test this week. My grandmother, who lived in eastern Pennsylvania, passed away this past Friday. Because I am still not comfortable with driving because of my reduced vision, I flew to Pennsylvania to grieve with the rest of my family, and attend my grandmother's funeral. I wasn't real worried about the flying affecting my transplant because I had talked to my doctor prior to surgery about traveling post-op. My doctor told me I could travel as soon as one week post-op as long as I didn't have complications. With almost four week post-op, I didn't have any major problems with flying. I did experience some pressure and discomfort, but no pain. Due to an eventful experience coming back, I did learn a valuable lesson. Always carry-on any medications you are taking. Finding an open drug store at midnight in an unfamiliar city is not fun.
Thurs 5/4
Had my four-week post op visit today and some slightly better news. Although I hadn't been noticing any changes in my vision, I was able to read the 20/200 line unaided, and the 20/80 line with the pinhole device. The doctor told me he would begin to take out some of the interrupted stitches at my next visit in three week. I am having some anxiety about where my vision will end up because I still seem to have some flairs and glares even with the new transplant. Hopefully things will improve.
I am to return to the doctor's office in three weeks. As for the medications, this is my current regiment: For one week use Pred Forte 3x/day, Polytrim 2x/day, Muro 128 4x/day, Doxycycline 2x/day, and eyewashes at bedtime with baby shampoo followed by Ilotycin ointment. After one week, reduce the Pred Forte to 2x/day, and the Polytrim to 1x/day. All other medications are to remain the same.
Weds 5/31
It's been three weeks since my last writing. I continue to have unusable vision in my left eye.
I am getting tired of continually explaining to my coworkers that this is a slow healing process, and my vision will change as my doctor manipulates my stitches through the healing process. Tomorrow I have my visit to the doctor, and if everything is looking okay, he will begin to remove the stitches.
Thurs 6/1
Had a very interesting visit to the doctor's office today. My vision unaided was worse. I could no longer read the 20/200 line. The surprising part was that I could actually read the 20/70 line with the pinhole device. This is one line better than my last visit. The doctor had a corneal topography done of my transplanted (left) eye. Although I wasn't able to obtain a copy, it looked much better than my pre-op topographies. There was definitely an astigmatism that could be seen with the topography. The upper right half of my eye was the black and blue that is normally associated with a normal cornea, while the lower left half ventured into the realm of red showing the steepness of the cornea. The doctor confirmed this under the microscope, and then gave one of his resident's instructions to remove two of the interrupted stitches, the one at 10 o'clock, and the one at 4 o'clock.
The removal was painless, but a little nerve racking. The resident gave me an anesthetic drop, and then used some sort of small blade to cut the stitches. Although I couldn't feel it, I did hear a small "pop" as he cut the sutures. Next came the forceps to remove the stitches. After several nerve racking minutes, and some more unusual sounds, the stitches were out. The hardest part of the entire procedure was trying to keep myself from moving my eye.
My next appointment will be in two weeks. Until then my meds are as follows: For the first three days, Pred Forte 3x/day. Polytrim 3x/day, Muro 128 3x/day, Doxycycline 2x/day, and eyewashes at bedtime with baby shampoo followed by Ilotycin ointment. After the first three days, reduce the Pred Forte and Polytrim to 1x/day. All other meds are to remain the same.
Thurs 6/15
Interesting visit today at the doctor's office. I was still only able to see 20/200 unaided on the eye chart, but with the pinhole device, I could read down to the 20/40 line! The doctor had another corneal topography taken of my eye and then removed 2 more stitches, so now I am down to 8 interrupted stitches plus the running stitch. My next appointment will be in two weeks, until then my meds are: For the first three days, Pred Forte 3x/day. Polytrim 3x/day, Muro 128 3x/day, Doxycycline 2x/day, and eyewashes at bedtime with baby shampoo followed by Ilotycin ointment. After the first three days, reduce the Pred Forte and Polytrim to 1x/day.
Mon 6/26
Okay, I think constantly putting drops in my eye is really starting to get to me. I am finding that I am missing more and more and must now concentrate to get the drops into my eye. Oh well, in the end it will hopefully be all for the better.
Thurs 6/29
Had my eleven week post-op visit today. The vision unaided was a little better reading at 20/100, and I still managed to read part of the 20/40 line with the pinhole device. The doctor had a new toy to play with, a new Keraton corneal topography machine. The difference I noticed were 1) the concentric rings of light were pink, 2) the concentric rings of light became wider as they neared the lens of the camera, 3) the unit had a distance measuring device, and actually took the picture when it felt the eye was in the right place. The biggest difference I could see was in the gradation of color. With the old topography unit, the image appears rather bitmapped. The new unit has a general gradation capable of much more detail. As for my actual topographical map, most of the picture was blue (good), with what looked like a thunder storm of green and yellow passing over the lower left of my eye. The doctor removed two more stitches from the lower left of my eye (for those counting, 6 interupted stitches removed, six remaining plus the running stitch).
I saw a side to my surgeon I had never seen before. He was excited about his new topography machine and talked about it for several minutes with one of the residents. We also got into an interesting discussion about whales when I talked about my upcoming trip to the beach. It seems whales have extra thick corneas that provide distortion free viewing at depth, and the cornea is actually bifocal. As for me going to the beach, he said there wasn't anything I needed to avoid except for scuba diving (yes, he actually had a corneal transplant patient go scuba diving a few weeks after surgery), he even said I could get my eye wet
Fri 6/30
Throughout the afternoon Thursday, I had the best vision yet to date. I could easily read my computer screen, watch excetera. I knew from the previous suture removals that the vision tends to change for the first few days after the removal, and although I wasn't suprised, I was disapointed this morning that my vision wasn't as good as it was yesterday. The vision isn't any worse than it was prior to my doctor's visit, just not as good as it was yesterday afternoon. I seem to be riding this wave between excitement and disappointment. I am excited because I can actually see and read some things out of my left eye unaided. With my right contact out, I can actually see the world around me with my left eye. I can watch televison and read a clock easily from four feet away. My disappointment is in the ever fluctuating vision that just doesn't seem to improve fast enough for me. I know that the vision will continue to change over the next three to six months and I must be patient, but there is a part of me that is tired of being patient (or was that the patient). I have to remind myself to be thankful that everything is going relatively well, and I show no signs of rejection.
Tues 10/24/00
It has been some time since I have updated this site. My reasons are rather selfish. I have had a long recovery with many things not going as planned. Fortunately, things have changed for the better in the last month. This past week, I received my first RGP for my left eye. The contact fit perfectly, and I have 20/25 vision with it.
My emotions have gone all over the place in the past week. One of my first shocks came shortly after the lens fitting. While using the rest room I finally saw my face for the first time in over a decade. It was a moment of elation, surprise, wonder, and fright. Driving the forty-five minute back to Akron, I could finally read street signs, see cars clearly, and was much less frightened driving. I am seeing the world I have missed. I find myself looking around more because I can now see faces beyond ten feet. I have never cried tears of joy before, but I cried them the day I received my lens.
So what has gone on in the past four months? Well for one a roller coaster of emotions where I dealt with bouts of depression over how my eye was progressing. My eye healed too fast, and the doctor ended up removing all the stitches, even the running stitch, because he could no longer control the cornea's healing. After a few weeks, I was left with a severe astigmatism, and once again could not even read the E at the top of the eye chart. The doctor decided to do a procedure called AK in which he used very precise blades to put two incisions back into the wound area of the new cornea. When doing this procedure, my doctor tries to go through as much of the cornea as possible without actually perforating the cornea. Unfortunately, on the second incision, the doctor perforated the cornea. The doctor tried using pressure patches over the weekend to try and close the wound and reduce the weeping of fluid from the inside of the eye. By the Monday following the AK procedure, things had become worse. A doctor appt. had turned into emergency surgery to close the incision with a stitch. Needless to say, I pretty much lost it at this point.
Because I wasn't expecting surgery, I didn't have any means to get back home. Fortunately I have some great friends who arranged to have me picked up and see me home. Also, not expecting surgery, I had eaten breakfast and wasn't allowed anesthesia for the operation. This did not turn out to be as bad as expected. Basically, the anesthesia really is used to keep patients from freaking out about the nerve block. The nerve block is injected into the cavity around the optic nerve by inserting the needle directly below the eye. The nerve block was actually pretty painless; I just felt some pressure around the eye. The rest of the procedure went well and had the desired effect of closing the wound and stopping the weeping.
Other than some bruises on the white part of the eye, post emergency surgery has been fine. The doctor has decided to leave the stitch in for now, and as you know, I went to the lens fitter to get a new contact. Without any correction I currently see 20/200. With glasses I see 20/60, and with contacts I see 20/25. I am currently off all eye drops and show no signs of rejection (knock on wood). Also, I am currently able to wear my contact about nine hours and I still building. Life is making a turn for the better.
Friday 11/3/00
Well, I had a set back this week. My eye wasn't tolerating the new contact, so I ended up seeing my lens fitter again. It turns out that caused an abrasion where the edge of the contact comes in contact with the cornea. The lens was actually a little loose, which, although unusual, can cause a corneal abrasion. The doctor took away the contact and ordered me a new one, so its back to the land of the blind for a short while. The good news is that there is still no signs of rejection, and the one remaining stitch is still tight.