Saturday, 9 August 2008

Success, but what happens next?

In my latest trip to the Manchester hospital (phew, it's getting tiresome, all this travelling but at least most of it is on the train), I got to see Miss Fenerty, the senior consultant who has been so helpful to me and who has placed this drainage shunt implant in my eye. The pressure was a remarkable 10mmHg which is the lowest it's ever been since records began! It's the bottom end of the normal range now instead of way up above it. This means that the laser zapping last time to unblock the tube has worked. It also indicates fairly clearly that the pressure is properly controlled for the first time - and all without drugs. In fact in 3 weeks, I shall be completely off eye drops, the last one I'm using (an anti-inflammatory) being tailed off to zero over this period. Then I shall be drug-free for the first time since the glaucoma was originally diagnosed back in 1976. I took the opportunity to congratulate Miss Fenerty. I'm pleased to be off the drops not least because they may have affected my mental state, pushing me into depression, a known side-effect of some of them. I will now find out if this theory is correct.

But what now? At present, the vision remains very poor and I have double images too. What can be done about it? There are several options and another specialist, Mr Ho (I think), joined us to discuss what to do. Or rather, they discussed and I listened mostly. Mr Ho specialises in corneal transplants (see figure) and I shall probably need one soon. The inner lining of my cornea - called the epithelium - is damaged. This means it can't pump water out of the cornea into the anterior chamber of the eye from which it would drain through the tube. So the cornea is waterlogged which gives me vision like looking through a fog. The damage has been due to the glaucoma and also because of the intra-ocular lens implant I had done about 12 years ago which has become loose and has moved and is physically damaging the epithelium. The epithelial cells cannot regenerate themselves when they are compromised in this way. (The cornea is said to be 'decompensated'.) Hence the probably need for a donor cornea some time in the near future.

The issue is the lens, known as the ACIOL (Anterior Chamber Intra-Ocular Lens). This needs to be removed soon and replaced, but by what? Because my iris was partly removed in the original cataract operation back in 1972, there are no proper anchorage points for a lens - which is why there's trouble with the one in there now. Further damage has been done by the 10 subsequent operations. So how do they fit a new lens and anchor it? There are various possibilities, none sounding ideal, but Miss Fenerty is arranging for me to see a lens specialist at the hospital so he can take a look and see what would be the best option. The results of that consultation will be my next post in a few weeks time.

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