The Eye Surgery Collection

The other night I was talking to someone who had a rare eye condition, and was looking at surgery. As it happened, that condition was keratoconus, and the surgery was a cornea transplant, which are things I have some experience with. So I said I'd do a post collecting my eye surgery posts, which is what this is, and which is what these are:

I guess it's better than a sharp stick in the eye. Looks like it's about time for another cornea transplant.

As sharp sticks in the eye go, that wasn't so bad. Not nearly as bad as what I remembered from the first time.

A word or two about "discomfort." It's uncomfortable.

It's 2:00 a.m..... Things are different when you don't have to go to work in the morning.

And now, a little blasphemy. And this is the judgment, that the light hath come to the world, and men did love the darkness rather than the light, for their eyes were photophobic.

More blasphemy. Still photophobic.

Nothing to see here. Move along now. No news is no news.

Now see here! And a good result is a really good thing.

Another visit to the eye doctor. And another surgery in the works.

A sharp stick in the other eye. We've got a date.

"I've never seen that happen before." What happened when it came time to do the other eye.

What I like best about being off work: Things are different when you don't have to go to work in the morning.

What I like best about being off work:

It's about 3:30 in the afternoon and I'm having a glass of 2002 Joh. Jos. Prüm Riesling Kabinett Wehlener Sonnenuhr.

For breakfast.

"I've never seen that happen before."

"I've never seen that happen before." Are there any more comforting words you can hear from your doctor in the middle of eye surgery?

When the IV didn't go the first time, I should have known that the stars just weren't right. But I'm not superstitious, so I didn't think anything of it. But I should have.

I was scheduled for a Lamellar keratoplasty. That's a type of eye surgery. A type of cornea transplant, to be precise.

In a Lamellar keratoplasty, they only remove a portion of the cornea,leaving the endothelium intact. In a penetrating keratoplasty, on the other hand, they cut the whole thing out and replace it with a new one. But perhaps I should elaborate.

The last time I had one of my corneas swapped out, it was a penetrating keratoplasty. And it was a penetrating keratoplasty because I'd had a penetrating keratoplasty on that eye before, and once the endothelium's gone, it's gone. And once it's gone, the tissue they graft on loses about 4.5 % of the cells each year. The cornea gets thinner and thinner until it cannot hold its shape or it becomes cloudy or both. Any way you slice it, vision suffers.

When I first had a cornea transplant 15 years ago, this fact was not appreciated. Or at least it was not communicated to me. I was under the impression that once they replaced the diseased cornea, the operation was good for life. I was under that impression because that's what the doctor told me. Unfortunately, such was not the case, an the operation had to be repeated. And repeated it was with more than satisfactory results. I now see better out of my left eye than I have in decades.

Unfortunately, I did not have such happy results with my right eye.

I had done the calculus of pain, balancing the cost and discomfort of surgery and the prospect of having to have it redone every 15 years or so with the gain in vision, and decided that I didn't want to have my right eye done. I could see well enough out of my left eye, and my right eye wasn't all that bad (correctable to about 20/100).

But then there was the Lamellar option. By peeling off and replacing only the outer layer of the cornea and leaving the endothelium intact, the cell loss should be avoided. So I arranged for some time off work, ponied up the not insubstantial cash payment of the deductible and the co-pay, and had the surgery.

But it didn't work. My endothelium was too thin or the cut was too deep or something, and there wasn't enough of an intact layer to peel off the old cornea but still leave the necessary tissue intact. So the surgery had to be aborted and the old cornea stitched back in place.

Ouch.

Really. It's quite discomforting.

My initial impulse was to go ahead and get the penetrating keratoplasty done ASAP. I'd already paid the deductible, took time off work, and suffered the initial pain of recuperation, so what's another couple days? So I scheduled another cornea transplant for the following Monday (it would have been Friday, but they didn't have a suitable cornea available). But then I though about having to have it redone every 15 years or so and changed my mind. I still have until December to change it back and still get the second operation done under the same deductible.

I don't know whether the problem that my endothelium was too thin or that the instrument just cut a bit too deeply, or some combination of the two, and I really don't care. Shit happens, as they say. Given the delicacy of the work and the extraordinary precision required, I'm amazed that this sort of surgery ever works at all. I hope my day job isn't causing the doctor to lose too much sleep over it.


By the way-- The surgery was last Wednesday. It's now early Wednesday morning, a week later, and this is the first time I've been able to keep my eyes open long enough to write this.

And by the by the way, although my eye's been rather inflamed and inoperative the last few days, the day after the surgery I was seeing much better than before, even though it was just my old cornea stitched back into place. It could have been better or worse or the same, but so far, it seems that I've gotten an inadvertent improvement. So I guess it's not a total loss.

A sharp stick in the other eye.

August 3. For those who follow that aspect of the blog.

Another visit to the eye doctor.

I saw the eye doctor again last week. Everything continues to look good, and Dr. Goosey for the first time expressed some enthusiam for doing the other eye.

This is something that I really wasn't sure I wanted to get done because after you have a penetrating keratoplasty (which is what I had on my left eye), the new cornea begins losing cells and after ten to twenty years the graft fails and the procedure has to be repeated. My thought was that as long as I was able to see out of one eye, it would be better to leave the other one alone.

Well, it turns out that a penetrating keratoplasty isn't the only option for my right eye. Apparently, the cornea is layered like an onion. It can be cut to the desired depth and then peeled off, leaving a layer of the original tissue in place. The replacement tissue is then sewn in on top of the remaining original cornea. The procedure is called a lamellar keratoplasty, and Dr. Goosey tells me, it has been shown to avoid the cell loss problem.

So I guess I'll have to scrape together another few thousand dollars and schedule a week or two off work.

One of these days.

Now see here!

Today was the day the sutures were supposed to come out. But it was not to be.

I arrived at Dr. Goosey's office at about 11:15, a half an hour before the appointed time. When the time came, they took me back where they keep the expensive eye doctorish equipment and did a map of my eye with a machine whose name I do not know. It has a bunch of concentric blue circles that I suppose it projects on the eye. Then it takes some sort of picture, and a computer makes a topographical map of the eye.

After they took the picture, I was taken to another room for the obligatory numbing drops and pressure test, and interview with the technician (or nurse or whatever her job title is). I asked her how many of the sutures he'd take out on the first visit, and she said it varies. They look for sutures that are too tight and pulling things out of shape. Apparently, by selectively removing the sutures, they can adjust the shape of the cornea as it heals.

Then another move to another waiting room, and after awhile a move back into another examination room. After a bit more waiting the doctor showed up. He asked whether it had been three months since the surgery, and I confirmed that it had indeed been at least three months, and this was the appointment where the sutures were supposed to start coming out. He looked through the chart for the picture, but it wasn't there because it was still in the printer. At least that's the last place I'd seen it, which is what I told him.

Dr. Goosey retrieved the picture and returned to the room. He said he wouldn't be taking any sutures out that day. I thought this was a bad thing, but it wasn't. It showed only two diopters of astigmatism (or something like that), which is apparently an extraordinarily good thing at this point in the recovery. It seems I'm mostly just nearsighted now.

Anyway, the doctor had one of the technicians do a refraction (I think that's what they called it), and I ended up with a prescription that will let me see 20/30 with glasses, which is considerably better than I've seen in years.
So after I got back to Beaumont, I picked up my glasses and headed out to the one-hour glasses place, and an hour later, I had a new left lens. The difference is amazing. It's hard to believe that normal people get to see that clearly all the time.

Next appointment in six weeks. In the meantime, there's a Fatboy that's been sitting unused in the garage for entirely too long. I'll be remedying that presently.

Nothing to see here. Move along now.

I saw Dr. Goosey again today. And he saw me. He said that everything looks good, and that he thinks that I wil be very pleased with the outcome. But that won't come until afte rthe stitches come out. And that won't start until my next appointment, which is scheduled for mid-January. After that, my vision should gradually get better over the next three months.

On a side note, while looking over my chart and discussing it with someone to whom I have never been introduced but who has been there for every exam (I assume she's an M.D. working on her opthamology specialization), he told her to pull my chart because he wanted to use it for a talk he would be giving on Saturday (I don't know which Saturday). Apparently, I'm a textbook case. Or at least something worth talking about. Or at least it's apparent that Dr. Goosey thinks there's something instructive about my case.

More blasphemy

"Then the fourth angel sounded: And a third of the sun was struck, a third of the moon, and a third of the stars, so that a third of them were darkened. A third of the day did not shine, and likewise the night." Revelation 8:12

Mmmmm.... Soothing dark. That would be sweet. .

And now, a little blasphemy.

"And this is the condemnation, that the light has come into the world, and men loved darkness rather than light, because their deeds were evil." John 3:19.

I can relate. But I wonder whether it wasn't just because the light hurt their eyes. I find the darkness--the cool, soothing darkness--such a relief from the merciless, burning, unrelenting light of day.

But that's just me.

It's 2:00 a.m.....

It's 2 A.M......

It's 2 A.M. the fear has gone
I'm sitting here waiting the gun still warm.
Maybe my connection is tired of taking chances
Yeah there's a storm on the loose
Sirens in my head
Wrapped up in silence all circuits are dead.
Cannot decode my whole life spins into a frenzy...

Maybe it's not that dramatic, but you get the point.

Or not. (Incidentally, the credits go to Golden Earring, Twilight Zone.)

And it's really 3 a.m., and I didn't have a connection. But still....

I did walk down to the office (driving is still a bit of a no-no). Checked my e-mail and so forth, and walked home. Maybe 3 miles each way. I haven't measured it.

It was a cool, though humid night, and not at all unpleasant. The dog seemed to enjoy it, anyway.

I love not having to get up for work in the morning.

A word or two about "discomfort"

Speaking of Discomfort.

Okay. So after the surgery, Mom drove me to Galveston, where I would spend the next couple days recuperating. I was surprised at how little “discomfort” I felt. Then at some point I scratched my head and realized why I felt so little discomfort. The entire left side of my face, from the cheekbones up Was numb, as was my scalp on the left side of my head. The aftereffects of the shot in the eye, no doubt.

When I had a cornea transplant 14 years ago, once the anesthetic wore off, the pain was excruciating and unrelenting. This time it was only burning and piercing. Still, a bit more than Tylenol was competent to handle. So I (okay, it wasn’t me, it was Mom) called the number on the post-op form and got me a prescription for Vicodin. It didn’t come close to stopping the pain, but it did take the edge off enough to let me sleep (something I didn’t get to do the night after my last cornea transplant).

Anyway, I still had the eyeshield taped over my left eye, and I kept my right eye closed most of the time. It was tolerable.

I had a follow-up appointment on Thursday, so Mom drove me back to Houston. My eyes were closed the whole way, but the light still hurt.
The doctor checked the pressure, looked at the graft, etc., and pronounced it “almost perfect.” He said he thought I’d be very happy with the results. They gave me some lovely parting gifts—some eye drops, wrap-around cataracts sunglasses, and a few other goodies—and sent me on my way, with the understanding that I’d call them immediately if the pain got worse, and that I’d come beck in two weeks for a follow-up.

So I went back to Galveston and watched TV with my eyes closed. I think there was a parody of a Presidential debate on most channels. It was pretty funny. One guy was a pompous blowhard who could only say “I would do better” or “I have a plan,” but never had anything substantive to say. The other one sounded like he was going to cry.

It hurt to open my eyes, or to move my eyes around much. And my left eye drips like a leaky faucet. And I have a Gollum-like aversion to light. Even with the dark glasses. Even the White Face, it hurtssssess our eyes, yessss, it hurtsssesss......

Then it was Friday. And much to my surprise and/or delight, the Sci-Fi channel was having a Farscape-a-thon (see previous post on “Firefly.”) I “watched” several episodes (to the extent you can “watch” a show with your eyes closed most of the time). I quite enjoyed it.

And then later on Friday afternoon/evening, I found my way home. Thanks, Mom.

And now it's Saturday evening and I'm bored out of my mind. It hurts to look at the computer screen (even though I'm wearing sunglasses and I have the brightness turned down to 5%) and I can barely read it. It's like looking through frosted class.

Oh well.. In another three months, the stiches come out, and three months after that, I should be as good as new (or atlleast as good as I'm going to get).

As sharp sticks in the eye go, that wasn't so bad

I had the surgery last Wednesday. That would be the cornea transplant surgery referenced in a previous post.

I arrived at the Gramercy Outpatient Surgery Center a bit before 7:00 a.m. I filled out a few forms, and after a not annoyingly long wait was taken back to the place where they stick needles in you and things, which they did in the nicest possible way.

They hooked me up to the blood pressure cuff and the machine that goes “ping,” the nurse/technician ran through my medical history, and then asked which eye they were going to perform the surgery on. I said “left,” and she asked me to point to my left eye. Which I did. And then she put a sticker over my left eye. Just so there wouldn’t be any confusion later, I imagine.

Next came the only painful part of the procedure. After spending a longer than average time patting the back of my hand trying to get the vein to do whatever it’s supposed to do, the nurse gave me a shot of something to numb my hand when the put in the IV. It stung a bit. The IV didn’t hurt at all.

Then the anesthesiology staff came around and ran through my medical history again and explained what they were going to do. Basically, this involved knocking me out for about five minutes when they’d give me a shot in my eye to numb it during surgery. The assured me that, although I’d be awake during the surgery, I wouldn’t care.

So the anesthesiologist told me there might be an ache in my hand when they started the anesthetic. I waited for the ache that never came, and next thing I knew, I felt like my eye had been taped shut. And there was something stuck in my nose that itched. It was an oxygen tube, presumably to wake me up. Which it did. I asked if my eye was taped shut, and they told me that it had a balloon on it. I didn’t ask what that meant.

I don’t remember a whole lot of what happened after that. I vaguely remember being wheeled into the operating room I remember looking up and seeing a sheet. I thought about asking whether they’d pulled the sheet over my face because I’d died on the table, but I thought better of it. Instead, I think I thanked them for covering my other eye so I couldn’t see what they were doing. I think they adjusted the anesthetic, because I don’t remember anything after that. Except vaguely seeing something through the eye they were operating on, but I think they were done by that time.

I somehow ended up sitting in a chair in the recovery room. I vaguely remember getting off the gurney and sitting down. I had a metal “eye shield” taped over my eye. I sat there for a not terribly long time, and was gone by 9:30. They told me I’d feel some “discomfort” after 6 or 7 hours when the shot in the eye wore off.

My compliments to the cast and crew at the Gramercy Outpatient Surgery Center. They were frighteningly competent and made eye surgery as comfortable as humanly possible. They all did a really fine job.

I’ll get to that “discomfort” part later. I’ve about exhausted my ability to look at a computer screen for the time being.

I guess it's better than a sharp stick in the eye.

I saw the doctor today, and it looks like this is not going to be as easy as I had hoped.

During the summer of my first year of law school, I had a cornea transplant in my left eye. After the surgery, I had to wear a metal "eye shield" for about 6 weeks to keep my eye from getting bumped. I was able to take some classes during the summer because I could still see out of my right eye.

In the intervening 14 years, my right eye has gotten considerably worse, and it's now much worse than my left eye was prior to the surgery. It has also been discovered in those intervening 14 years that a cornea transplant isn't good for life, as was thought back then, but actually has a life span of about 20 years at the outside. Mine worked well for 13 years, but started falling apart about 6 or 8 months ago. It's gotten to the point now where it is painful to read for more than a few minutes at a time. And that requires closing one eye and squinting.

When I saw the doctor a couple months ago, he was hopeful that he could do what they humorously call "relaxing cuts" to flatten out the cornea. Can you imagine the kind of sick mind that calls sticking a knife in your eyes "relaxing" cuts? Anyway, the tests they did today revealed that the cornea has deteriorated to the point that I need transplant. He was looking for a cell count of 1000-2000, and mine was only about 500. I feel so inadequate.

After the operation, I will not have any use of my left eye (since it will be covered by a metal eye shield), and my right eye is already practically useless. During the recovery period, I might be able to read, but only for short periods and with considerable eye-strain. I'm figuring this will get me some time off work. And it's about damn time. I haven't had a real vacation in years. This might get me a whole month off. And all I had to do was let someone stick a knife in my eye!