The first few days after having the bandage contact removed were pretty sore but it quite soon got to the stage of being uncomfortable 'only on occasion'. The cyclopentolate drops were still disabling the eye's function so vision was totally cloudy. Patience.
Two weeks in and the cyclopentolate drops were stopped. The immediate effect was that the eye was sore again. Presumably the flexing of the cornea as the eye attempted to focus was causing irritation. Only lasted a couple of days though. Now, the eye is sore only 'sometimes'.
Then vision began to develop. I could make out some things: those are books on that bookshelf! Very blurry and indistinct but definitely books. (I can't do that with the graft in my other eye without my contact lens.) There's no short-distance vision at all, yet. But already my uncorrected mid-distance vision is better than pre-op. I know vision will change dramatically over the initial recovery period so need to keep the excitement measured. Final outcome is still unknown. Good start though.
My uneducated guess is that the hyperopia (long sight) is due to the corena being too flat. As the eye adjusts I imagine the cornea will 'fill out' a bit more and my short sight improve. Of course there is no way of knowing what the final vision will be, either short or long distances. This is very different from my first graft so seems like a good news.
The three week checkup showed the timolol had worked and eye pressure reduced to a healthy 13 (from 26 just 2 weeks before). Good. Vision through a pinhole was good, well down the chart. Good sign for the future. Vision varies widely from moment to moment as tear fluid moves unevenly over the eye's surface. Sometimes it appears to be a bubble moving over the eye's surface. Consultant assured me that, as the cornea becomes smoother, as the gully around the graft flattens out and when the stitches are removed this problem will go. (Hope it goes before the stitches: it makes vision very difficult.)
A stitch at the bottom of the eye has 'rotated' and is not 'bedding in' properly. (It was unclear if this has been the case since the operation, rather than being a recent change.) Since it is not causing much of a problem it was decided to leave it, as is. The options were to try to rotate it or to fit a bandage contact again. This could be the reason the eye is still sore sometimes. This stitch will be removed early, especially if it becomes a focus for infection, but this can never be before 6-8 weeks. The plan is, as last time, to remove half the stitches after about a year.
Drop regime for the next period: pred forte x3 and timolol x2 but can now discontinue the chloramphenicol antibiotic. Next checkup in a month.
Still really tired. Not sure if that's coincidental or a natural part of the recovery.
Thursday, 2 October 2008
Saturday, 20 September 2008
Week One
It took several days to feel that the anaesthetic had fully worn off but don't feel I need that excuse for late mornings and afternoon naps.
The hospital had made no mention of wearing an eye shield at night. This must have been an oversight. Fortunately I have an old one I can use.
The first thing to do on discharge was to make a chart of exact times for each set of eye drops. Alongside this regime I was using 2 hourly comfort drops for the contact lens in my other eye. That was fine until I inadvertently used the cyclopentolate in my unoperated eye. It took 4 days for its pupil to return to its normal size and to start functioning properly. Fortunately the lens-focusing muscles were disabled for less that 24 hours. I really should have thought to flush the eye out immediately. When I reported this faux pas at my hospital checkup, they just laughed.
The first check up was a week after surgery. See my nice Registrar again....
I queried the necessary restrictions on lifting and carrying since I spotted it was not mentioned in the guidance leaflet. I was told that there was no absolute certainty that there was a connection. However it was felt that 'common sense' said that care should be taken, particularly at first. He felt that after c6 weeks, on my return to work, there should be no problem with carrying ordinary loads, such as student notes.
Sometimes the eye had been quite sore, though not scratchy or gritty. It was agreed that this was probably due to dry eye. When asked if I could use any of my current drops to help, it was agreed that preservative-free celluvisc (or artificial tears) would be fine.
The leaking stitch has stopped leaking - good - so the bandage contact has been removed - bad. The upshot is that the eye is very much more irritated than previously and is really quite scratchy and sore. Back to the paracetamol packet.
The cornea surface is now uneven. Apparently this is normal, with the healing leading to stretching between the stitches. It is expected to smooth out later. Vision is probably somewhat worse than day 1: line 1 is barely legible even though a pinhole. No concern: still very early days.
Eye pressure was elevated though, at 26. This is slightly higher than desired. So a beta blocker is added to the list of drops (0.25% timolol ie Timoptol). New regime is: Predforte (4x daily); chloramphenicol (4x daily); cyclopentolate (3x daily) (for one more week only though); timolol (2x daily) and celluvisc as required.
The prescription for the timolol and extra chloramphenicol both came in single-dose preservative free form. Not clear if this is an error or deliberate. Must query next time.
Next check up in 2 weeks.
Alongside this, the optometrists have decided I need a slightly stronger lens in my right eye. It has been ordered. After that I'll need to upgrade my reading glasses.
The hospital had made no mention of wearing an eye shield at night. This must have been an oversight. Fortunately I have an old one I can use.
The first thing to do on discharge was to make a chart of exact times for each set of eye drops. Alongside this regime I was using 2 hourly comfort drops for the contact lens in my other eye. That was fine until I inadvertently used the cyclopentolate in my unoperated eye. It took 4 days for its pupil to return to its normal size and to start functioning properly. Fortunately the lens-focusing muscles were disabled for less that 24 hours. I really should have thought to flush the eye out immediately. When I reported this faux pas at my hospital checkup, they just laughed.
The first check up was a week after surgery. See my nice Registrar again....
I queried the necessary restrictions on lifting and carrying since I spotted it was not mentioned in the guidance leaflet. I was told that there was no absolute certainty that there was a connection. However it was felt that 'common sense' said that care should be taken, particularly at first. He felt that after c6 weeks, on my return to work, there should be no problem with carrying ordinary loads, such as student notes.
Sometimes the eye had been quite sore, though not scratchy or gritty. It was agreed that this was probably due to dry eye. When asked if I could use any of my current drops to help, it was agreed that preservative-free celluvisc (or artificial tears) would be fine.
The leaking stitch has stopped leaking - good - so the bandage contact has been removed - bad. The upshot is that the eye is very much more irritated than previously and is really quite scratchy and sore. Back to the paracetamol packet.
The cornea surface is now uneven. Apparently this is normal, with the healing leading to stretching between the stitches. It is expected to smooth out later. Vision is probably somewhat worse than day 1: line 1 is barely legible even though a pinhole. No concern: still very early days.
Eye pressure was elevated though, at 26. This is slightly higher than desired. So a beta blocker is added to the list of drops (0.25% timolol ie Timoptol). New regime is: Predforte (4x daily); chloramphenicol (4x daily); cyclopentolate (3x daily) (for one more week only though); timolol (2x daily) and celluvisc as required.
The prescription for the timolol and extra chloramphenicol both came in single-dose preservative free form. Not clear if this is an error or deliberate. Must query next time.
Next check up in 2 weeks.
Alongside this, the optometrists have decided I need a slightly stronger lens in my right eye. It has been ordered. After that I'll need to upgrade my reading glasses.
The op
So, after a restless night, I turned up for the graft on my left eye on Thurs 11 Sept, as requested at 1 o'clock.
My previous visit to the ward had shown it to be crowded and chaotic with mixed-gender patients milling around and equipment everywhere. It was not a pleasant prospect: so much inferior to the now-redundant but purpose-built eye hospital where I'd had a graft 6 years previously. The reality was not too bad though. The ward has around 40 beds but divided into separate rooms. Initially I was in a 4 bed single-sex room, with its own bathroom, and later moved to a similarly-equipped 6 bed room. There was far too much noise from staff during the night but otherwise the environment was not unnecessarily unpleasant.
The ward manager booked me in very efficiently and informed me that I was first on the list for the afternoon's surgery. So, unless those plans changed, I had an hour. In that time I was to discover that white knee-length compression socks are now de rigeur for all surgery. Very fetching. Slightly elevated BP 135/67 with fast (for me) pulse of 73.
A junior anaesthetist arrived to see me first. I told him the saga of my last visit and he very closely read the notes from my GP. He was happy to proceed. Phew. Later, in the anaesthesia suite I realised that the anaesthetist who was giving me the anaesthetic was the doctor I'd met last time - the junior was dealing with the mask and oxygen. He didn't acknowledge me let alone make any mention of our previous meeting: I don't know if he was aware of the sequence of events.
The opthamologist who saw me pre-op introduced himself as the Registrar. He seemed so young... but despite that confident and reassuring. He was both pleasant and professional. I felt I could ask him what his role in the op was going to be. I hope he didn't feel that to be threatening: I tried to assure him I was simply curious. I certainly didn't want him to increase any anxiety he might be feeling. (That wasn't entirely honest though. I suspect the 'less than perfect' outcome of the previous graft in the other eye was due to the inexperienced work of the Registrar on duty that day.) His answer was that he expected to be doing the 12 infill stitches, after the consultant had positioned the graft with the first four.
The operation took place first as scheduled, so I had almost no waiting time. Good. I was wheeled to the theatre waiting area down two floors, using the public lifts. Apparently they are more readily accessed than the private lifts. Then to a holding area next to the operating theatres. 'Lambs queuing for slaughter' was the image invoked. Having felt so disoriented immediately post-op last time I got the orderlies to point out where I'd be taken for recovery.
Very soon I was moved again into the anaesthesia suite and the anaesthetic was quickly handled. But there were some bizarre aspects like being told that they'd keep my pillows in the anaesthesia suite for me after the op since pillows left on ward beds (presumably in the corridor) often disappear.
The op replaced a 7.75mm diameter of my distorted cornea with a 8mm diameter disc from a donor.
The next time I was aware of anything much I was back in the ward. I didn't notice being in recovery nor going back up 2 floors in the lift. As far as I can tell I think the op took about 1 hour 30 mins. I can remember the oxygen mask being removed then, apparently immediately, being told my oxygen level was dropping and I needed to take a couple of deep breaths. I recall the cannula being removed from my hand. So, so thirsty. It was probably quite a while before I was anything remotely like full conscious. Certainly they took my BP 3 times in that period: 131, 137 then a better 117, I think. This was about 4:30. I recall, presumably whilst still in recovery, the anaesthetist saying to the nurses 'be generous'. Paracetamol and codeine were given - 2 of each.
A request for a cup of tea lead to a response that the tea trolley will be around soon. A jug of water was delivered, complete with ice. Lovely. Drank loads in an attempt to rehydrate. Fearsome headache developed. It took me a while to realise that this was being induced by the water temperature: started to remove the ice from the drinking cup. A refill was requested without ice. This was abruptly thumped on the table, the auxiliary pointedly, sneeringly saying 'without ice'. "Thank you." The headache soon cleared.
Around 5 o'clock the dinner trolley came around. I wasn't offered any food but really didn't care. Tea trolley around 5:30 yielded a very welcome cuppa. About this time beds were relocated between bays in order to free up some beds for men. This was nothing like as alarming and disorienting as a similar experience had been last time: this time my unoperated eye (even without its contact lens) had enough vision to allow me to move around, find the loo and so forth. Made a huge difference.
Husband visited from about 7. At about 7:30 I was offered a snack. Macaroni cheese came around 8. Much better to wait until then than to try to eat through the earlier fuzziness. More painkillers some time after 9 then try to sleep. Noisy night, uncomfortable bed, aching eye, short snatches of sleep.
Morning tea came at 6 o'clock. Why? Nothing happened for a further hour: the drugs round. More painkillers - thanks. The nurse came to remove the overnight dressing from my eye and put in my first drops: Predforte (anti-inflammatory steroid), cyclopentolate (pupil dilator & lens disabler) and chloramphenicol (antibiotic). She said the doctor would be up to see me between 8 and 9 and expected that I'd be able to go home after that.
The doctor, the young Registrar, arrived to see me shortly after 8. His verdict was that the new cornea was nice and smooth in both directions - good. However there was a slight leak along the extreme left stitch. He agreed that fitting a bandage contact would be a good idea, because of the leak, though usually their use would be avoided since they increase the risk of infection. That suited me fine. I remember from last time just how hugely they increase comfort. I could just about make out much of the top line on the eye chart. Eye pressure was a healthy 13.
Discussions with the nurse, I was discharged about 8:50 on a regime of Predforte (2 hourly), cyclopentolate (3 times a day) and chloramphenicol (4 times a day). Husband arrived and we went home, via the eye dept to get a bandage contact lens fitted.
My previous visit to the ward had shown it to be crowded and chaotic with mixed-gender patients milling around and equipment everywhere. It was not a pleasant prospect: so much inferior to the now-redundant but purpose-built eye hospital where I'd had a graft 6 years previously. The reality was not too bad though. The ward has around 40 beds but divided into separate rooms. Initially I was in a 4 bed single-sex room, with its own bathroom, and later moved to a similarly-equipped 6 bed room. There was far too much noise from staff during the night but otherwise the environment was not unnecessarily unpleasant.
The ward manager booked me in very efficiently and informed me that I was first on the list for the afternoon's surgery. So, unless those plans changed, I had an hour. In that time I was to discover that white knee-length compression socks are now de rigeur for all surgery. Very fetching. Slightly elevated BP 135/67 with fast (for me) pulse of 73.
A junior anaesthetist arrived to see me first. I told him the saga of my last visit and he very closely read the notes from my GP. He was happy to proceed. Phew. Later, in the anaesthesia suite I realised that the anaesthetist who was giving me the anaesthetic was the doctor I'd met last time - the junior was dealing with the mask and oxygen. He didn't acknowledge me let alone make any mention of our previous meeting: I don't know if he was aware of the sequence of events.
The opthamologist who saw me pre-op introduced himself as the Registrar. He seemed so young... but despite that confident and reassuring. He was both pleasant and professional. I felt I could ask him what his role in the op was going to be. I hope he didn't feel that to be threatening: I tried to assure him I was simply curious. I certainly didn't want him to increase any anxiety he might be feeling. (That wasn't entirely honest though. I suspect the 'less than perfect' outcome of the previous graft in the other eye was due to the inexperienced work of the Registrar on duty that day.) His answer was that he expected to be doing the 12 infill stitches, after the consultant had positioned the graft with the first four.
The operation took place first as scheduled, so I had almost no waiting time. Good. I was wheeled to the theatre waiting area down two floors, using the public lifts. Apparently they are more readily accessed than the private lifts. Then to a holding area next to the operating theatres. 'Lambs queuing for slaughter' was the image invoked. Having felt so disoriented immediately post-op last time I got the orderlies to point out where I'd be taken for recovery.
Very soon I was moved again into the anaesthesia suite and the anaesthetic was quickly handled. But there were some bizarre aspects like being told that they'd keep my pillows in the anaesthesia suite for me after the op since pillows left on ward beds (presumably in the corridor) often disappear.
The op replaced a 7.75mm diameter of my distorted cornea with a 8mm diameter disc from a donor.
The next time I was aware of anything much I was back in the ward. I didn't notice being in recovery nor going back up 2 floors in the lift. As far as I can tell I think the op took about 1 hour 30 mins. I can remember the oxygen mask being removed then, apparently immediately, being told my oxygen level was dropping and I needed to take a couple of deep breaths. I recall the cannula being removed from my hand. So, so thirsty. It was probably quite a while before I was anything remotely like full conscious. Certainly they took my BP 3 times in that period: 131, 137 then a better 117, I think. This was about 4:30. I recall, presumably whilst still in recovery, the anaesthetist saying to the nurses 'be generous'. Paracetamol and codeine were given - 2 of each.
A request for a cup of tea lead to a response that the tea trolley will be around soon. A jug of water was delivered, complete with ice. Lovely. Drank loads in an attempt to rehydrate. Fearsome headache developed. It took me a while to realise that this was being induced by the water temperature: started to remove the ice from the drinking cup. A refill was requested without ice. This was abruptly thumped on the table, the auxiliary pointedly, sneeringly saying 'without ice'. "Thank you." The headache soon cleared.
Around 5 o'clock the dinner trolley came around. I wasn't offered any food but really didn't care. Tea trolley around 5:30 yielded a very welcome cuppa. About this time beds were relocated between bays in order to free up some beds for men. This was nothing like as alarming and disorienting as a similar experience had been last time: this time my unoperated eye (even without its contact lens) had enough vision to allow me to move around, find the loo and so forth. Made a huge difference.
Husband visited from about 7. At about 7:30 I was offered a snack. Macaroni cheese came around 8. Much better to wait until then than to try to eat through the earlier fuzziness. More painkillers some time after 9 then try to sleep. Noisy night, uncomfortable bed, aching eye, short snatches of sleep.
Morning tea came at 6 o'clock. Why? Nothing happened for a further hour: the drugs round. More painkillers - thanks. The nurse came to remove the overnight dressing from my eye and put in my first drops: Predforte (anti-inflammatory steroid), cyclopentolate (pupil dilator & lens disabler) and chloramphenicol (antibiotic). She said the doctor would be up to see me between 8 and 9 and expected that I'd be able to go home after that.
The doctor, the young Registrar, arrived to see me shortly after 8. His verdict was that the new cornea was nice and smooth in both directions - good. However there was a slight leak along the extreme left stitch. He agreed that fitting a bandage contact would be a good idea, because of the leak, though usually their use would be avoided since they increase the risk of infection. That suited me fine. I remember from last time just how hugely they increase comfort. I could just about make out much of the top line on the eye chart. Eye pressure was a healthy 13.
Discussions with the nurse, I was discharged about 8:50 on a regime of Predforte (2 hourly), cyclopentolate (3 times a day) and chloramphenicol (4 times a day). Husband arrived and we went home, via the eye dept to get a bandage contact lens fitted.
Wednesday, 10 September 2008
A 3 month period of uncertainty
So what happened next?
Well the sniffle didn't go away. Several visits to the GP and trials with anti-histamines and nasal steriods and the current view is that the unfortunate 'sniffle' is actually rhinitis, some sort on allergic reaction. It only really cleared up when we holidayed on a cliff-top with clear sea air.
So the op is scheduled for tomorrow, 3 months after the aborted op. Because of the nature and timing of my queries I've ended up having 2 months notice of the appointment. It became clear that the hospital gives the eye bank 3 months warning of their requirements, specifying the operation date, so why do they give the patient only a month's notice?
Because of the nature of my job (I'm a University lecturer) I've ended up spending those 2 months doing all the preparation for the 6 weeks I expect to be away from work. It's been phenomenally busy.
So I'll go to the hospital in the morning, armed with my steroid nasal spray and a note from my GP, and hopefully the anaesthetist will be happy that it's safe to go ahead with the operatation.
Well the sniffle didn't go away. Several visits to the GP and trials with anti-histamines and nasal steriods and the current view is that the unfortunate 'sniffle' is actually rhinitis, some sort on allergic reaction. It only really cleared up when we holidayed on a cliff-top with clear sea air.
So the op is scheduled for tomorrow, 3 months after the aborted op. Because of the nature and timing of my queries I've ended up having 2 months notice of the appointment. It became clear that the hospital gives the eye bank 3 months warning of their requirements, specifying the operation date, so why do they give the patient only a month's notice?
Because of the nature of my job (I'm a University lecturer) I've ended up spending those 2 months doing all the preparation for the 6 weeks I expect to be away from work. It's been phenomenally busy.
So I'll go to the hospital in the morning, armed with my steroid nasal spray and a note from my GP, and hopefully the anaesthetist will be happy that it's safe to go ahead with the operatation.
Tuesday, 3 June 2008
Disappointment
So, I had a very sleepless night, full of the inevitable anxiety and thirst. Got up really early and arrived at the hospital at 8. Ward was very busy but I was told I was first on the list, for the morning at 9 o'clock. "Good" me-thinks, get it over quickly. No bed available which meant I was left watching really dreadful breakfast TV in the day room. "We'll get you one when people go home."
After 45 minutes, with 9 o'clock getting ever closer, the anaesthetist arrived. All was fine until I mentioned I'd got a slight sniffle. Oh dear: downhill from then on. The anaesthetist wasnt willing to give me a general anaesthetic and went off the discuss with the eye surgeon the option of doing it under local. Would I be happy for this? "Yes." I refrained from telling him that I'd asked for this previously (I'm curious) but the surgeon had been adamant that he wouldn't do it then. So I wasn't surprised by the final outcome
The precise details of the next 3 hours are not important but featured: more breakfast TV; more conversations with the anaesthetist; moving to a different waiting area; waiting for the surgeon to come to talk to me in person to be told "he'd left". The staff who dealt with me were universally pleasant
So, it's back on the waiting list for more donor tissue to become available. I expect to get a few weeks warning of the re-scheduled date. I'll be back here, then.
After 45 minutes, with 9 o'clock getting ever closer, the anaesthetist arrived. All was fine until I mentioned I'd got a slight sniffle. Oh dear: downhill from then on. The anaesthetist wasnt willing to give me a general anaesthetic and went off the discuss with the eye surgeon the option of doing it under local. Would I be happy for this? "Yes." I refrained from telling him that I'd asked for this previously (I'm curious) but the surgeon had been adamant that he wouldn't do it then. So I wasn't surprised by the final outcome
The precise details of the next 3 hours are not important but featured: more breakfast TV; more conversations with the anaesthetist; moving to a different waiting area; waiting for the surgeon to come to talk to me in person to be told "he'd left". The staff who dealt with me were universally pleasant
So, it's back on the waiting list for more donor tissue to become available. I expect to get a few weeks warning of the re-scheduled date. I'll be back here, then.
Monday, 2 June 2008
Context and a bit of background
Tomorrow I shall be having my second corneal transplant. By 'second' I mean I'm having my second eye treated. These grafts are to deal with the effects of advanced keratoconus. This blog will be a diary of events, of stages through treatment and recovery. I hope it may be of interest to some others, facing similar surgery.
The first graft was done in 2002. I wrote a diary about the first graft. That's publically available on my 'keratoconus' web page: http://www.coventry.ac.uk/ec/~lisa/kerato.htm I'll use this blog this time.
My dad tells me that it must be better this time 'since I know what to expect'. But how wrong he is. It wasnt a good experience but the outcome is that my vision is vastly improved in that eye but it has taken a very long time and a lot of frustration in getting this far.
I do know I need to go ahead with this second graft: contact lens comfort in that eye is getting problematic; air bubbles are a frequent problem and the lens needs re-inserting several times each day. So I don't realistically have a choice. At 8 am tomorrow I'll turn up to the hospital for surgery.
The first graft was done in 2002. I wrote a diary about the first graft. That's publically available on my 'keratoconus' web page: http://www.coventry.ac.uk/ec/~lisa/kerato.htm I'll use this blog this time.
My dad tells me that it must be better this time 'since I know what to expect'. But how wrong he is. It wasnt a good experience but the outcome is that my vision is vastly improved in that eye but it has taken a very long time and a lot of frustration in getting this far.
I do know I need to go ahead with this second graft: contact lens comfort in that eye is getting problematic; air bubbles are a frequent problem and the lens needs re-inserting several times each day. So I don't realistically have a choice. At 8 am tomorrow I'll turn up to the hospital for surgery.
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