Hard graft

I've just returned from what just might be my last eye operation at the Royal Eye Hospital in Manchester. Why the last? Because if this one does as it should, reasonable vision should return to my troublesome eye within the next few days or weeks.

The run-up: I wrote about what was to be done in my previous post. Mr Au, the specialist, had already determined that I should need a full-thickness (or penetrating) keratopathy (graft). Mr Au was fully prepared to video my operation - at my request - but in the event was unable to do so because the video cables in the brand-new hospital were not compatible with his laptop. For the curious, I've added a YouTube video below of the entire procedure showing how the damaged cornea is cut out and the donor one is placed in the hole and sutured. There's no blood and I find the whole proceedings fascinating and incredible.

What happened? Val and I drove to Manchester on Sunday where I was admitted to be ready for action on Monday. Mr Au bounded into the ward on Monday morning and directed me to an examination room with the usual slit lamp and tonometer (for examining and measuring pressure in the eye respectively). He remarked that the old cornea had deteriorated noticeably since he'd last examined me and gave me a run-down on what he would be doing, knowing that I was very interested in the procedure. Then there was the interminable period of waiting, made more endurable because not only was Val there, but Suzanne and her new baby boy, my grandson, Aaron, were there too. The wonderful new hospitals have plenty of space for walking about, sitting, eating and drinking. Aaron sat on my knee and smiled and gurgled for quite a while.

I was last on the list for the afternoon and was not allowed anything to eat or drink after my breakfast at 6am. Finally, I was gowned-up and checked several times to make sure there were no mistakes and walked the long walk down the long, brightly lit corridors to the operating theatres and anesthaesia room. It helps to have been through this before but it's always scary. A while later, I came round in recovery and was soon back in the ward. A remarkable thing about modern anesthaesia is that within minutes of coming round, you're ready to walk about and have a good meal. It used to be that you felt horribly nauseous. Not now. So I had my tea and Suzanne helped me out of the gown and into my normal shirt again. They all had to leave by early evening since Suzanne had to get a train back to Sheffield and Val, after seeing them onto the train, had to get a tram and bus back to nephew Dale's house where she was staying. (Thank you, Dale and Debs!)

And the results? I'm sure everyone reading this will want to see what my eye looks like now(!). So here it is:
Not a brilliant self-portrait but you can see the clear central cornea from the donor and just make out the tiny sutures - there are 16 of them - anchoring the graft in place. The white patch on the right was placed there 18 months ago by Miss Fenerty as part of the glaucoma tube operation she performed. This is also from a donor. So my right eye now contains two pieces of other people's eyes. Thank goodness for donors! What a noble thing to do when your life is cut short: bequeath useful parts of your body so that others might see (and many other things) again. Both Val and I are registered donors.

Mr Au examined me yesterday (Tuesday) morning after I'd had a surprisingly good night's sleep with little pain, and pronounced me fit for discharge. The graft was looking good and the pressure was normal. The operation had gone smoothly, he said, and although my vision was - and still is - quite poor, this is perfectly normal. But it is better than it was before and should slowly improve over the next few days and weeks.

And so I was discharged but, owing to some sort of procedural cock-up, Val and I weren't able to actually leave until nearly 5pm because my prescribed eye drops hadn't been sent down by the hospital central pharmacy. A small matter but irritating at the time. It meant Val had to drive back in the dark, through heavy rush-hour traffic and jams because of an accident on the motorway and, later, heavy rain after we entered Wales. She managed supremely well but was quite exhausted when we got back.

I have to sleep with an eye shield covering the eye for a month and not do any heavy work which could damage the slowly-developing seal between the new cornea and surrounding old corneal periphery. The sutures may need to remain in place for 1-2 years and there is a slight possibility that the donor cornea will be rejected by my immune system. I have to be very careful to avoid infection because, when you think about it, there's quite a large cut surface which bacteria would just love to invade. Accordingly, I'm using antibiotic and anti-inflammatory eye drops 4 times a day for the time being. As I write, the eye is a little sore and scratchy when I blink but this should quickly pass. I go back for a checkup in a week when I will find out how things are going. So back to long train journeys again... but at least I can see.

So hoorah for the eye hospital staff and hoorah for the good old NHS!

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:

• 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.

The Big Operation

I returned yesterday from my 2 days sojourn in horrible Manchester. No complaints about the treatment though. The 'suite'; (not called wards anymore apparently) was pleasant enough and the staff efficient and helpful. The 'wonderful Miss Fenerty' (as Val calls her) who is the senior consultant and the woman who conducted the operation with her team came to see me before the ordeal and answered my odd remaining questions. We then discussed planting our potatoes. I've done mine; she's still not got hers in.

Twenty minutes later, I was clad in my gown and whisked down to the anaesthetic room. This was where panic bubbles up to the surface and I had to resist a strong urge to do a runner. I didn't, of course. But this was the culmination point of all my endless nervous re-runs of how horrible it would be. They were all very kind, reassuring and professional as they plugged me in to various sensors and stuck a needle in a vein. Then, ever so slowly, the room began to spin and I muttered something about feeling drunk before passing out.

Some time later, I returned to the world of consciousness. The operation had taken 2 hours, Miss Fenerty later told me. Soon, I was back in my room,shared with another man who was in a state of near panic, this being his first ever eye operation. I think I was able to reassure him a little beforehe was whisked off for his operation. Certainly, he came back later much happier that it was all over. It was nowhere near as bad as he'd thought itwould be. As for me, my principal discomfort was my back aching after enforced lying for several hours. Assisted by Val, who had braved trams and getting lost in the big city to come and be with me, I moved to a chair and was soon pacing the corridors, much to the amusement of one of the black nurses who laughed with delight every time Val and I paced past, arm in arm, as if promenading on the deck of a ship. The jolly nurse said she wished she had a camera.

A little later, Miss Fenerty came to see how I was and Val was able to meet her 'wonder' at last. She said the operation had gone well though she'd had difficulty finding a suitable site for the plate and tube because of all theprevious failed operation sites. She'd had to patch up some leaky bits of thin tissue from these at the same time as locating the drainage plate (called a Baerveldt plate, pictured). Then she had patched that all over with donor sclera. This is slightly weird, knowing about and being able to see this piece of sclera (the white of the eye) which came from someone who died and had generously agreed to donate their eyes so that others like me might retain their sight. I shall never know who this was but I feel thankful for this ultimate gift. I shall, in a few months, probably receive a donor cornea too, once the glaucoma trauma is all healed and working properly.

I spent a second night in hospital so that Miss F and her team could examine me before discharge. All seemed to be well and in due course, I got a massive bag of drops and pills which I have to take at, depending on what they are, 1,2 3,4,5 and 6 times per day. I also have to swallow 15 steroid tablets. I think this is to suppress any immune reaction to the donor tissue which could theoretically be rejected, and helps keep inflammation minimal.

The eye is not a pretty sight at present but I can see out of it in a blurry fashion. Val nobly braved the scary city traffic and came in to collect me and it was with relief that we were soon speeding from a grey, rainy Manchester into a mostly sunny Wales. It was so nice that we went to Bodnant Gardens and had a brisk walk amongst the camelias and daffodils and a welcome cup of decent coffee in the National Trust cafe.

Coming home was wonderful. It was mild, still and sunny and all the birds were singing for spring is in the air. Snowdon looked wonderful in its cover of snow which fell last week.

I have to return for regular checks, starting on 4 April but I shall be ableto do this alone and go by the much more relaxing train. Today, I have been semi-back-to-normal, helping Val with veg packing (she did the bending; Idid the bagging) and assembling all the bags when Jill came with her contribution. I've also sown all my tomatoes - in heat. So, even though dosed up - literally - to the eyeballs with drugs, I feel fine. I'm being very careful as you'd expect. Obviously I don't want to jeopardise in anyway this 'last chance' operation and I won't. I won't know how successful it's been for another 4 weeks or so because the drainage device is designed to come into proper operation when a securing stitch dissolves away. And if the drainage isn't sufficient, then Miss F can tweak the device in a very small operation so that more fluid drains through the tube to be dispersed under the conjunctival membrane and thus absorbed into the blood stream.

It is, I think you'll agree, incredible what can be done with malfunctioning eyes. The eye is obviously tougher than you'd think and able to take a lot of damage. My eye is certainly an old hand at being cut up! And I think that's enough of this gruesome stuff. Meanwhile, full marks to the wonderful National Health Service. People love to grumble about it, but it works pretty well under often difficult conditions. And thanks to Miss Fenerty and her excellent team.