Monday, 28 July 2008

A nasty shock and some zapping

Once again, I trekked to Manchester last Friday for a check 2 weeks after removal of the supramid suture (previous post). It was a hot day and the hospital outpatients pretty busy. This time, I saw Miss Lewis who is a highly competent and professional member of Miss Fenerty's team who I've seen before. She checked the pressure which had previously been an acceptable 20. This - for me - was the moment of truth: had this Ultimate of glaucoma operations been a success? The pressure reading was, rather shockingly, 38. Way too high! I was in despair but the brisk Miss Lewis had a very careful look around the eye and brought in Miss Fenerty (always available to see intractable patients like me) who confirmed what she thought was going on.

Because my original lens was clumsily removed with its capsule in 1972 - a procedure called intracapsular extraction and not now carried out - there is nothing save the inserted artificial lens to separate the aqueous humour at the front of the eye from the vitreous jelly which fills the eyeball. Because the artificial lens inserted at Torbay hospital about 12 years ago has moved out of place slightly, shreds of the jelly are actually being sucked into the tube draining the eye and had, like a cork in a bottle, blocked the entrance to the tube. Not surprising, then, that the pressure had rocketed.

But there was a solution, albeit temporary. Miss Lewis conducted me to their YAG laser room almost immediately. Because this was a sort of operation, I had to sign a 'consent' and then she began the process of zapping (and it really sounds like that) the blockage using a special large contact lens pressed gently into my eye. It's not a painful procedure; just uncomfortable and I find I jump slightly with each zap, not knowing when she was going to do it. She had a little trouble with air bubbles under the contact lens but ended up zapping the blockage about 30 times. Then she pressed my eyeball with her finger and declared that she thought it was softer and that she had been able to see little zapped bits actually being sucked through into the tube which suggested it was now clear and draining rapidly. A pressure check back in her room quickly confirmed that the pressure had plummeted to 20. Phew! She asked me to come back in half an hour before leaving to see if the pressure had stabilised.

Half an hour later, she whisked me into her room again, measured the pressure and said, with a half smile, "It's 18. Now get out of here before there's any more trouble!" I did, feeling much relieved because it is now fairly clear that the tube implant operation is doing its job properly just so long as it doesn't block again. Of course, it could block again and Miss Fenerty said that what they will probably do now - and she needs to consult other specialists about this - is go in to the eye and remove the displaced lens, replacing it with one properly suited to my difficult eye and at the same time, clear out these shreds of debris. Whether they'll be able to do the proposed corneal graft at the same time I don't yet know. I'm going back, yet again, in 2 weeks and should learn more. I'm all for getting all these things done as soon as possible because my vision is still very poor. Miss Lewis advises me to go to a local optician to get the pressure checked this week - in case of further blockages. If it's high again, I'll be summoned back to the hospital and something will be done fairly quickly. Unfortunately, there are no symptoms of high pressure, the insidious thing about glaucoma. Permanent damage is done to the optic nerve and you're unaware of it.

So who knows what will happen next? I am heartily sick of all this travelling but there is light at the end of the tunnel...

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