I've had two visits to the eye hospital within 7 days, not because there was anything untoward but because I had appointments with different specialisations. The first was the retinal clinic where I had various tests which showed that the swelling of the macula had 'dried out'; the oedema has gone. I don't notice much improvement because I can't see much anyway for a different reason: my compromised (it's called 'decompensated' in the jargon) cornea. So the macula appears to be normal again.
A week later, I went to see Mr Au who is the specialist in corneas and corneal transplants. The cornea is the 'front window of the eye'; the part that does most of the focusing of the image which it projects onto the retina. Mine is severely damaged from all the operations I've had and because of years of glaucoma. The endothelial cells on its inner surface, if damaged, cannot renew themselves but are vital as they pump water from the cornea. If this pump isn't working, the cornea becomes waterlogged causing the blurry vision - like looking through a ground-glass screen - that I have. The only cure is to replace the endothelial cells with a graft, a new and delicate operation called a DSEK or to replace the entire cornea (full-thickness keratopathy). In either case, the graft comes from a donor, someone who has died young and generously left their eyes to be used for helping the likes of me. I already have a piece of somebody else's eye in my eye, the result of the patch graft which Miss Fenerty placed over the tube and plate she inserted to control the glaucoma - which, I am happy to say over a year later, it does effectively. As a result of this anonymous post mortem generosity, I have registered as an organ donor; the least I could do.
I had only a short wait to see Mr Au himself. He is very brisk and efficient and pleasant with it. He did several tests on different machines to enable him to determine with precision what exactly would be the best option for my eye. For various compelling reasons to do with the geometry of my 'difficult' eye, the intra-ocular lens and pupil, he feels that the best course is for me to have a full thickness keratopathy. In this operation, he makes a circular cut - using an instrument like a cookie-cutter, though a little more refined - to actually bore out a hole in the front of my eye about 7mm in diameter. Into this, he inserts a donor 'button' - the replacement cornea - which he then sutures firmly into place using very fine radial stitches. The sutures remain in place for around 18 months and I will need steroid eye drops to prevent rejection. But the new cornea should mean that I can see clearly again. At present, the image quality is so poor that I get no image fusion, no stereoscopic vision, and can barely make out the biggest letter on the standard eye chart. If I don't have this graft, the outlook is worsening vision and pain associated with the oversaturated corneal tissue. I've already had a lot of pain with this cornea and I know how unpleasant it is. The operation is not without risk but the benefits are significant.
So the choice is easy! I'm on the waiting list for an operation in about 3 months.
Showing posts with label macular oedema. Show all posts
Showing posts with label macular oedema. Show all posts
Saturday, 18 July 2009
Thursday, 29 January 2009
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.
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.
Tuesday, 4 November 2008
Next steps
I had another visit to the hospital yesterday, starting at 4.30am when the alarm woke me with time to drive to Bangor and catch an early train. This visit was rather different for I was to see a new consultant (in a different clinic) who deals with intra-ocular lenses and retinas. For the time being, the glaucoma is controlled by the tube implant.
After preliminary examinations by a junior doctor, I saw Mr Charles, the consultant, a very busy man who is constantly being interrupted by juniors seeking advice about the patients they are examining. The same sort of thing happened with Miss Fenerty.
Mr Charles had a very close look at both my eyes, pronouncing my normal one to be healthy as he did so. That's good news. As for my troublesome eye, he laid out the options. Option 1 was do nothing which would result in poor vision getting worse as the dispaced lens inside does ever more damage to the cornea's internal surface, causing increasing cloudiness - oedema - and resulting in time in virtually no vision. The lens might even slip round to the back of the eye, causing retinal detachment. Option 2 was to undergo a rather complicated operation under general anaesthetic during which he would perform several things:
After preliminary examinations by a junior doctor, I saw Mr Charles, the consultant, a very busy man who is constantly being interrupted by juniors seeking advice about the patients they are examining. The same sort of thing happened with Miss Fenerty.
Mr Charles had a very close look at both my eyes, pronouncing my normal one to be healthy as he did so. That's good news. As for my troublesome eye, he laid out the options. Option 1 was do nothing which would result in poor vision getting worse as the dispaced lens inside does ever more damage to the cornea's internal surface, causing increasing cloudiness - oedema - and resulting in time in virtually no vision. The lens might even slip round to the back of the eye, causing retinal detachment. Option 2 was to undergo a rather complicated operation under general anaesthetic during which he would perform several things:
- vitrectomy: removal of the vitrous jelly which fills the back of the eye. It was shreds of this which blocked the tube a while back
- an injection into the macular to clear the swelling which gives me the sea urchin effect I described in my last post
- removal of the displaced lens
- insertion and suturing of a new lens to replace it, a difficult thing to do given the state of my eye but, in his opinion, worth having a go at
He was quite open about the chances of success which are no more than good for an eye like mine. He's done many of these lens operations, he said, and none have gone wrong but there would always by a chance of various complications. My eye is, as he said, a very difficult problem. Even so, he seemed to think the risks worth taking, given the alternative. I agreed and the operation is to be in about 2 months. If the operation is successful, I should gain better vision but the cornea will not recover and so I may need a complete corneal graft in a year or so.
Before leaving, I had to have the usual pre-operative check-up: blood samples, ECG, MRSA swabs and so on. I also had to have some measurements of the eye to enable them to order a new lens to the specifications needed by my eye. These measurement were not easy, as it turned out, since the normal laser machine couldn't record anything because of the cloudy cornea. So the operator of the machine had to use an ultrasound proble pressed against the eye surface repeatedly. Her aim was to get consistent results and it was some time before she managed to do this.
I arrived home in the evening to an empty and dark house because Val had left that same morning to visit Suzanne in Sheffield for 3 days. I was rather tired having had a poor night's sleep - as one does when needing to get up very early. I had a good sleep last night and today, reflecting on what will be happening, feel fairly positive about it all.
Saturday, 11 October 2008
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...
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...
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