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.

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...

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.