Good eye news... for now

It's Thursday evening and I can see better with my damaged eye than I've been able to do for months... and that just over 24 hours after being out for the count in the operating theatre at the Manchester Royal Eye Hospital. Yes, I've had my operation and it went better than expected.

Val and I drove to Manchester on Monday early evening, a horrible busy drive when you're just used to seeing the postman and a few sheep. We stayed with my nephew Dale and his partner Deb, as previously when I was to have a major operation nearly a year ago. They live within easy public transport access (walk, tram, walk or bus) of the hospital to which I had to report by 12 noon the next day. Being there a day early made the journey much less nerve-racking. Val stayed with them while I was in hospital.

After being admitted on Tuesday, Mr Charles, the consultant examined me and we talked about the gravity of the operation. I fully understood that there were a whole raft of horrors which could occur because of my tricky eye which has been so much damaged by earlier operations. I reckon this was my 12th! There were three things to be done: an injection of Avastin to arrest the swelling of the macula (the central spot of the retina with the greatest concentration of light-detecting cells) which had been causing a semi blind spot in my central vision; removal of the old and displaced anterior chamber lens (ACIOL) and its replacement with a new one to be supported by suturing to the sclera which would also require the removal of all the jelly-like vitreous humour at the back of the eye (vitrectomy) which would be naturally replaced by the salty aqueous secretion from the ciliary body close to the iris.

Operation day came and I was gently knocked out by a very kind anaesthetist who was, he said, exactly the same age as me. A short time later, I came round and was soon back up in the ward amid rumours that things had gone rather differently than expected. I was puzzled by the lack of pain for a start and the short time in which this long and complex operation had been carried out by Mr Charles and his team. Later in the afternoon, Mr Charles appeared and after being introduced to Val - who was, of course, there with me - told me what had happened. He operates on the principle of 'do no harm' which could be paraphrased in my case as 'if it ain't broke, don't fix it'. After making one small incision with which to remove the misplaced lens, he found that the lens would actually very easily slip into the place it should have been and seemed quite secure. He was very happy at this point to not open up the eye any further for, as he had explained to me, every time this is done, more damage is done to the non-repairing endothelial cells of the inside of the cornea. This damage causes oedema, or waterlogging, of the cornea which results in the vision being variably foggy. So he decided to leave well alone, administered the Avastin injection to the macula and patched me up. And that was it. The incision, I understand, is so small that no stiches were needed. Hence the almost total absence of pain.

How long this will last is unknown. It could become displaced again in a few weeks or go on for 10 years. We just don't know. Mr Charles saw me again this morning for a final check before discharging me. All seemed to be well and no damage had been done to Miss Fenerty's fine handiwork (the tube implant, done nearly a year ago to control the glaucoma) with the pressure coming in at 10 (it is now normally between 10 and 15 whereas it used to hit the upper 30s when the glaucoma was out of control). I return to see him in 2 weeks for a routine check. I'm on the usual antibiotic and antiinflammatory drops and have to not stoop for about a week only. The eye - as I write - is painless and for the first time for months, I don't see multiple images. This means that the images from both eyes fuse properly and I get some rudimentary stereo vision. I can also just about see the letters on my laptop's keyboard. I couldn't before and as the Avastin does its job, I hope my central vision will improve some more. But with this much improvement already, I feel very pleased.

When I was waiting to be discharged this morning, I heard a cheery, "Hello Mr Lynas" in a familiar voice: it was Miss Fenerty who has so successfully sorted out my glaucoma. She remembered all about me (astonishing in my view since she must see dozens of patients every month) and we chatted briefly about her photovoltaic panels which are successfully feeding electricity into the grid. She wanted to know about the vegetables and how the weather had been for them. The upshot of this chat is that she plans to take up my invitation, proffered some time back, to come and visit Mur Crusto farm. I would, I said, be honoured!

Finally, I have to record with pleasure that my stay in hospital was made almost enjoyable by the kindly staff, male and female of all races and creeds. The food wasn't bad either, not something you hear many people say. There's lots of laughter on this eye ward, good therapy for any patient.

One damn thing after another

Sea urchins and soreness: I visited the Manchester Eye Hospital yesterday for a 2-month checkup. I was ready for it because my eye has been becoming increasingly sore - especially in the evenings - for some weeks. This was despite putting in various drops and ointments which make dry eyes more comfortable. But the eye didn't seem to be dry. For all the world, it felt as though there was a badly-fitting contact lens in there but without the remedy of being able to remove the lens. There's more: when I first open my eye in the morning, I see a strange black object right in the centre of my vision. It looks like a rather flattened black sea urchin, complete with spikes. I close the eye again and there's a negative after-image. As the day passes, this manifestation becomes less obvious but I notice that I can see more clearly (that's a relative term; the vision is just a total fuzz) when I don't look at an object directly.

Some good news: Those were the symptoms which I recounted to Miss Fenerty. Firstly, though, she checked the pressure. It was 10 (and had been 12 three weeks ago when I had it checked at the local optician). So there's some good news: it really does look as though the glaucoma problem which has affected me since Fiji days in the early 1970s (though I didn't then know it) is solved. Big plus for Miss Fenerty's surgical skills and knowhow.
The soreness seems to be related to the loose ACIOL (anterior chamber intraocular lens) about which I am being seen in early November by another specialist. This is constantly causing low-level damage to the eye which then reacts by becoming inflamed. Some steroidal eye drops, she thought, would help: Prednisolone. Twenty four hours later, as I write this, it looks like she's right. I'm using the drops and, so far, the eye has stopped being sore.

Introducing a new player: macular oedema To get a diagnosis of the 'sea urchin' issue, Miss Fenerty at once sent me off for a laser scan of the affected area of the retina. This remarkble procedure, which took about 20 seconds, resulted in weird-looking 3D images and cross sections of my macular (the central area of the retina which is packed with cone cells giving the acute vision we all need for detail like reading) which I then whisked back to Miss Fenerty. I have fluid which has accumulated underneath the macular, lifting the retinal layer like a hill (in the images) where no hill should be. The result is the symptoms I have described. The first line of defence is a non-steroidal anti-inflammatory called Acular - which I am now also using. The likely cause of this oedema (aka 'edema' [US] meaning 'waterlogging' and which already affects my damaged cornea) is this lens and the inflammation it is causing.
So I await my next visit in just over 3 weeks to see the ACIOL specialist, Mr Charles. By that time, we'll know whether the oedema is reduced and, if it's not, I would expect that another operation to remove the injurious lens and, I hope, replace it with a new and stable version, will be very soon after. The saga will continue...

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.