Can there be good news with glaucoma?

I went into the Manchester Royal Eye Hospital last Wednesday for another operation to be performed on Thursday morning, returning home on Friday. For once, travel was very easy. There was a direct train in both cases. I was even able to get a (free because I am over 60) bus back most of the way home. My stay in hospital was boring so I read a lot and listened to the radio on my mp3 player. Knowing how noisy things can be, I went equipped with ear plugs, very necessary since the man in the bed next to me specialised in gargantuan gurgling snores. There were four people in my room and the staff were efficient and cheerful but, because of the ethnic mix, sometimes a little hard to understand because of the potpourri of accents.

Read on for full details, but not if you're squeamish in which case, skip to the final paragraph.

The operation was to remove the supramid suture from the tube and plate implant in my eye. This is essentially a thin bit of string which partly blocks the tube implant so as to moderate the flow of liquid from the front of the eye. Although it sounds daft to have it there at all, there are good reasons for it. It is far more dangerous to the eye to reduce the pressure dramatically - a condition called hypotony - than to keep the pressure fairly high whilst everything heals up. For some people, the tube with its supramid thread is enough to relieve the pressure and nothing more need be done. Naturally, I am the difficult one who needs this extra tweak.

It was slightly bizarre lying on the operating table chatting to Miss Fenerty (surgeon and senior consultant) about wind turbines, green manures and her recent installation on her house of a 1.8kW photovoltaic device. We share many interests apart from eyes! I should add that this chat went on whilst she was anaesthetising the eye, not during the actual procedure which wasn't as easy as it should have been due, basically, to the fact that my eye has been cut open so many times that it contains a great deal of scar tissue which made inserting the original drainage tube and plate quite tricky. The process is in itself quite painful in some of its procedures like injecting anaesthetic into the tissues surrounding the eye which help immobilise the eye.

The supramid suture end normally lies under the conjunctival membrane (the clear covering over the white of the eye, the sclera) but it was difficult to locate because of the profusion of blood capillaries in the inner corner of the eye. Needless to say, Miss Fenerty and her assisting registrar finally spotted it and made a tiny incision and slowly, not without a little difficulty, reeled out the suture. They also removed several other stitches from other parts of the eye from the previous operation. All that remained to be done was for a dissolvable stitch to go in to close the incision.

Having an operation of this sort under local anaesthesia has its advantages. I was able to simply stand up and walk back to the ward after it was over and I get to hear all that goes on... which can be a disadvantage too. I found myself constantly having to consciously relax because I was so tense. Occasional sharp intakes of breath from me because of sudden intense pain resulted in instant reactions from Miss Fenerty who quickly added more lidocain. My eye is difficult to anaesthetise because, once again, of scar tissue and the location of the plate and suture which would normally be elswhere in the eye. But it was good to be able to ask the odd 'what are you doing now?' question and have it answered right away.

In my follow-up the next morning, the pressure was 20, top end of normal, and this without any glaucoma medcation. It had been 22 on the morning of the operation but that was with every single medication available including Diamox, the last resort which I've been on for 6 weeks when it was clear that the pressure was becoming way too high. Diamox has unpleasant side effects but it did allow me to go on holiday. So for the first time for decades, I am actually not on any glaucoma medication, some of which have side-effects of their own. In fact, I am still using eye drops, 4 times per day, but these are anti-inflammatory and antibiotic and are standard after your eye has been cut open.

My eye at present looks a little grotesque - all red as capillaries swell and grow to repair the damage done by the surgery. It's a bit sore and there's often a noticeable pricking sensation in the inner corner where the dissolvable suture is located. All this is normal and to be expected. The suture will dissolve and the soreness will dissipate. I have anti-soreness ointment and artificial tears to add when I feel the need of them.

I feel I should be celebrating this apparent success but I am hesitant to do so until I've been for my next follow-up appointment. Long dismal experience tells me that my glaucoma is an intractable condition and every effort to stop it in this troublesome eye is doomed to failure. I am optimistic though because I know I am in the hands of one of Europe's best glaucoma surgeons. The fact that Miss Fenerty has sent me off without medication suggests she is pretty confident that all should be well. The anti-inflammatory drops themselves cause an increase in pressure which should fall when I stop using them in a few weeks. On the evening of operation day, I met one of her deputies, the charming Mr Gandhi who I always ask to see when I go for checkups. We had a long chat about Green issues and about my eye, details of which he remembered perfectly even though he didn't have the notes and wasn't formally seeing me about it. One thing he said was that in his experience, removal of the supramid suture was usually sufficient to control the pressure and he knew of only two cases where further intervention had been needed. For further intervention is possible and, if necessary, can be repeated over and over again to keep the pressure controlled. It's a process called 'needling' in which the scar tissues blocking the exits from the plate are broken up to improve drainage. So it really looks like, one way or another, my glaucoma will be controlled.

There's more. At present, all I can see with my troubled eye is a fuzzy double image. Miss Fenerty and Mr Gandhi have told me of all the incredible procedures which can now be carried out to improve vision in people like me with 'compromised' corneas (the 'front window' of the eye). Miss Fenerty is optimistic that one or more of these will be suitable for me to regain some reasonable vision from this badly knocked-about eye. I will be learning more about these in the next few weeks. Meanwhile, one thing I have learnt from all this is patience!

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.