Pre-Op:
Nine days before the surgery, I had the required complete physical
exam, blood workup, and EKG. Despite just getting over a cold, I came
through with flying colors.
Seven days before surgery, I met with my eye doctor and surgeon Dr.
Herman Rundle. I had a list of questions for him:
Can I have a local instead of a general? Yes. Doctor said they could
administer a general to me at anytime during the surgery if I wanted it.
Will you talk to me during the surgery? (It would make me feel better)
He didn't promise anything.
I have developed an allergy to codeine. Is there other pain medication
I can use? He said Tylenol would be sufficient. There won't be pain.
When is the latest time I can eat? 8 hours before surgery. However, do
take my blood pressure medicine with a sip of water.
What type of stitches will you use? 8 anchor stitches and a running
stitch.
Length of time before I can bend or reach? He said unless it is extreme
bending or reaching, I won't be restricted. But I shouldn't lift more than
10-15 lbs. for awhile.
How much "rest" time? He said after the surgery I'd probably just sit
around until I saw him for post-op the following day.
Can I use the computer? Sure. (Whew!)
He gave me a paper and made me read it and sign it. It said:
"This note is to constantly remind me to call Dr. immediately if I
experience in my operated eye any of the symptoms mentioned below for
longer than 6 hours:
1. Eye pain or discomfort
2. Tearing
3. Blurred vision
4.
Redness
5. Photophobia
These are symptoms of a possible graft rejection which could destroy my
corneal transplant and my vision if left untreated."
Then he gave me instructions and prescriptions:
1. Shower and wash my face 3 nights straight with Dial soap to
forestall any bacteria.
2. Three nights before surgery stop the Muro and instead put in my eye
nightly a line of Ilotycin and rub it into my lashes about 10 X. It's an
antibiotic.
3. Two days before surgery, use two eyedrops every 4 hours while awake.
One is Ocuflox in a bottle, the other is Acular in single-use ampules.
Ocuflox is an anti-bacterial and Acular is an anti-inflammatory.
The morning of surgery I got up at 6 am, ate a bagel and an orange,
took my medications with 1/2 glass of iced tea, and went back to bed.
Consequently, I did not suffer severe hunger pangs the day of surgery. I
don't know why doctors don't tell patients that 8 hours is long enough,
instead of that flat "nothing after midnight" business. I kept my lips
moistened with hand cream to prevent chapping.
The day of surgery (I will call this Day 1), I checked into the
hospital at 1 p.m. A nurse gave me two kinds of drops, one an antibiotic
and the other something to dilate the pupil to protect the implanted lens.
Surgery was scheduled for 2:30, but they didn't get to me until 3:15. They
administered some kind of "blocker," and I never knew when they did it
(they ran some knock-out med through my IV for a minute, but I didn't even
know it). After I "woke up" (never having realized I was asleep) and the
blocker was working, I never felt anything from my operated eye and I saw
only light. My other eye was wide awake, however, and I pestered the
nursed who was cleaning my eyelashes about what solution she was using.
Now I forget what it was, but maybe it was saline and beta-something. Then
they put a small oxygen mask on me and covered my face with a plastic
sheet so I could no longer see from my other eye, and only the operated
eye was exposed. All the work being done on my eye showed to me as only
light patterns and colors.
There was a complication in my surgery because the pressure in my eye
went very high, making it impossible to put on the new cornea in a flat
enough position to allow stitching. They tried feeding some medication
through my IV, which helped reduce the pressure in the eye, but not
enough. Finally the surgeon (lucky for me he was experienced in retinal
surgery, too) removed some of the vitreous gel to lessen the pressure, and
then the transplant proceeded. I felt no pain during any of this. I could
hear what they were saying and could sense when the nurse handed items to
the doctor. I heard the doctor ask another nurse to explain to his next
patient that her surgery would have to be rescheduled, because mine was
going so long.
What this side adventure meant to me was a longer time on the table in
a confined position. Instead of the planned 1 1/2 hours, the surgery ran
just over 3 1/2 hours. Doctor frequently asked me if I was OK, and I said
yes. At one point they asked if I would like to be sleepier, and I said
yes. But I still was fairly awake. I didn't want to miss anything.
I was in recovery a little while. When I left, my instructions were not
to bend below my waist, not lift more than 10 pounds, and if I had to
cough or sneeze, do it through my mouth--don't let any pressure build up
in my head. Oh, also, go straight home and rest.
Because of the long surgery, we didn't get home until after 8 pm. I had
no pain around the transplant area. I was glad to get home, eat a quick TV
dinner, and go to bed. I knew I couldn't sleep on my operated side, so the
bed was already set up with pillows to keep me from rolling that way.
The next day (Day 2) I took it easy until the doctor's appointment. He
took off the plastic "tea strainer" and the gauze pad. My eyelid was
swollen, but once I blinked a little and got it open, the doctor took a
look and pronounced the transplant, "Gorgeous!" Then he called in another
eye doctor to have a look, and even let hubby peek into my eye. Hubby said
he couldn't believe all those teeny weeny stitches. Then the doctor asked
me to tell him how many fingers was he holding up. I said two. Right. He
backed his chair farther away. Now how many? Three. Right. Then he pushed
his chair clear back to the door. Now how many? I said, "Well, it's fuzzy,
but it's your thumb." Then he tested me with letters on the chart. He was
delighted and said, "You're already seeing 20/200!" I said, "Well, that's
better than the 20/300 I had yesterday."
He gave me an eyedrop regime using the antibiotics and
anti-inflammatory I already had, and something called Atropine. He
mentioned that one or more of them had no preservatives and on some of
them Dr specified "no generic substitutes." I could stop using the
antibiotic ointment. I had to work out a chart to get the eyedrops on a
schedule. He also told me to keep a soft gauze pad on the eye all the
time--up to a week--to remind myself to keep my eye closed, and suggested
I keep both eyes closed frequently to help the healing process. He said
the body would build a new epithelium over my new cornea. He said to take
it easy, not to read, but watching TV or working at the computer was OK.
He said I could shower and wash my hair, just keep my eye closed. I only
had to put the plastic eye protector on at bedtime or naptime.
The next day I rested a lot, but also ventured outside to have hubby
take my photo with some flowers from friends. I also went along with him
over to my real estate office to say Hi to the folks and get a hug or two.
By the end of the day I had a strong feeling of eyelash in my eye in the
inner corner. I took some Tylenol and it went away. I had some tearing,
too. The appearance of the eye was swollen and puffy, like I'd been crying
all night, but it was not bruised.
Saw doctor early next morning (Day 4), and he said my body has grown
25% of the epithelium back over the new cornea. I told him about the
tearing and lash in the eye. He said not to worry about the tearing at
this point, but the lash in the eye was a little end of a stitch sticking
up. He said he had "buried" the stitches so I wouldn't feel them, but this
one end was showing. He sterilized some tiny scissors and clipped off the
end of stitch. The eyelash feeling went away immediately. He also told me
that moving the eye around a lot might tend to make it feel more scratchy,
so I decided to spend more time resting with my eyes closed for the next
couple of days rather than working at the computer.
We discussed the way my eye pressure went up and caused that long
surgery. Apparently that is pretty unusual. Doctor said he was discussing
it with some other eye surgeons yesterday, and none of them had ever seen
that. His suspicion is that it was the local that caused the pressure to
rise. He said sometimes locals do that. It might be wise to get the other
eye done under a general.
The following morning, Saturday, I woke up at 5 am with a big
"toothache," but it was in my new eye! That scared the bejeebers outta me.
I had been sleeping on my back, and maybe my head had rolled toward the
operated side. Not sure. I got up for a half hour and fed my really sore
(even the eyelid!) eye one of its ACULAR PF drops and later an Ocuflox. I
dug out my doctor's direction sheet:
"...call Dr. immediately if I experience in my operated eye any of the
symptoms mentioned below for longer than 6 hours:
1. Eye pain or discomfort
2. Tearing
3. Blurred vision
4.
Redness
5. Photophobia"
I then calmed myself down and said, "If it still hurts by 10 am I will
call the doctor." Then I fed myself a pain pill, propped up all my pillows
so I was sleeping in a sitting up position rather than in a laying down
position, and slept soundly until 9 am. When I woke, I had no eye pain
whatsoever and felt great. Methinks it had to do with my sleeping
position. The rest of that day I felt fantastic.
Sunday Morning I noticed that my eye was a bit tender, but after the
drops and a shower, it was again fine. I ventured out with Hubby to the
grocery store, and it was quite a challenge to find things and avoid
getting blind-sided in the busy aisles. By the time we finished, my eye
felt tired and somewhat strained. But a little quiet time and the drops
helped. I began to look forward to the drops, which always seemed to
soothe the eye, although they often stung that area in the inner corner
for a moment. Toward evening I took off the gauze patch for awhile, but
mostly kept the eye closed. When I peeked out of it, I saw very bright
color but no focus. I had to remind myself that the healing takes a long
time, and even though the peskiness of the drop schedule and limitations
on my lifting had made it seem longer, my surgery was only five days ago.
A side note: because of all the hand-scrubbing before the eyedrops, my
hands had become very chapped, so I used lots of handcream. I figured out
how to stifle a sneeze and to take Actifed BEFORE the allergy attacks I
have when the sun goes down. I was also glad I had planned for prunes in
my diet. No further comment on that.
Saw the doctor again Monday, Day 7. My epithelium has regrown over 45%
of the new cornea. Pressure is still under 20. He wants me to keep the eye
covered until 100% regrowth of epithelium. Also add artificial tears in
between my RX eyedrop schedule. Do not let the eye get dry. I'm getting
into the eyedrop routine so much that if I haven't just done a drop, I
know it's time for another one. The names of my eyedrops: Ocuflox every 2
hours, Acular every 4 hours, Atropine every 12 hours, and Moisture Eyes by
Bausch & Lomb or Tears Naturale by Alcon for anytime in between.
On day 8 I broke out in a slight rash around my eye, an allergic
reaction to the bandage/patch. No big surprise. I never could even use eye
makeup or non-allergenic eye cream. Off with the patch.
On day 9 the eye doctor pronounced my epithelium 80% healed over. Only
a small pie shape was left to go. Pressure was down to 15. Keeping the
pressure down is crucial, because high pressure can ruin the transplant,
doctor said. He encouraged me to still keep the eye closed and to avoid a
lot of eye movement. I asked if I was healing slower than normal, and he
said yes, but I was healing well, nonetheless.
Day 10 was Thanksgiving. I felt great, but I was getting weary of
holding one eye shut, and the gauze bandage was out. So I rigged up a
mini-patch by cutting the bowl off a plastic spoon, smoothing off the
rough edge, scrubbing it well, and taping it over my eye. Helped a lot to
keep the eye closed without effort, and got me through Thanksgiving
dinner. I admit that my depth perception made for an adventure in eating,
with all the stemmed glasses and tall candles. We went to friends' house
for dinner, and I packed all my eyedrop paraphernalia in a plastic
container to take along and managed to stay on my drop schedule. As I was
getting ready for bed that night and putting on my "tea strainer," I
noticed that looking in the mirror through one of the openings in the
shield I could see my face in the mirror! Not sharp enough to put on
makeup, but sharp enough to recognize that it was me. Oh, happy day!! Only
downside today, the rash from the gauze patch is still red and itchy.
Day 11. Saw eye doctor. I am 90% healed. Continue drops & closing
eye when possible. I rested a lot.
Day 12. Went to lunch and visited family member in the hospital. Still
doing the plastic spoon thing. Carried my eyedrop kit with me and didn't
miss a beat.
Day 13. Eye doctor met me and 2 other patients at his office on SUNDAY!
I could read a couple more lines on the chart. Entire cornea is healed
except for 5 tiny spots on the lower edge. Continue drops and cover when
possible. I actually did some business calls today. Eye was plenty tired
by end of day, however. I look forward to drop time.
Day 14. Monday, and my job cried out for attention. I took care of a
lot of phone calls, updated necessary things in the files, did some
looking up of things in books, a lot of computer work. By the afternoon my
eye was sore and scratchy. I had both eyes open a good part of the time.
When I put the big plastic guard on for bed, I noticed I could read my
over-sized LED digital clock through one of the holes in the eye guard. I
had asked Doctor yesterday why I could read better through that pinhole
device at his office, and he said it controlled how much light was between
you and the object. He had a big long name for it, which I don't remember.
Day 15. Out and about shopping (not driving). As a precaution I wore
the plastic spoon/eye cover.
Day 16. Saw the eye doctor. My eye pressure still in the 12-15 range.
Cornea is healed except for 3 tiny spots at the bottom. Reduce Ocuflox
(antibiotic) eyedrops from every 2 hours to every 4 hours. Cornea is
remaining round, and not tending to any oval shape. Doctor said I can
resume my normal activities but should try to close and rest both eyes an
hour or so a day.
Day 18: Last night I got some extra pain in my eye--a dull ache. I was
really scared. This morning it was better, but not much. I called the eye
doctor for an unscheduled appointment. Of course, you know how it is, by
the time you get to the doctor, it doesn't hurt anymore! I thought I had
overdone it yesterday, because I showed 3 houses, wrote an offer on two of
them, and never had time to close my eyes and rest, nevermind being hit
and miss on my eyedrop schedule. Real Estate is a NOW business.
Got in to see the doctor about 3, and was very happy to hear him say
the eye was not in trouble. It was still "quiet." The dull ache was from
inflammation, and now that I am healed he will start me on cortizone drops
to relieve that. I was also ecstatic that my vision checked in at 20/70
minus 1 in the transplanted eye! On my best days BT (before transplant) it
was 20/80. However, he really REALLY wants me to keep that eye closed as
much as possible and not moving all over the place, so I'm back with the
"plastic spoon" patch I rigged up. My doctor ordered NO GENERIC on this
Pred Forte. So now I am up to 4 RX eye drops a day plus liquid tears.
Considering that I used to be a girl who couldn't help blinking, now I
could put those drops in riding bareback at full speed on a camel! (Just
kidding)
Day 19: I overdid it again today, but it was worth it. We saw a holiday
concert with a 100-voice male chorus, and then we saw a 37-voice boys'
choir. I defy anybody to see a concert like this and not get a tear in the
eye here 'n there. Hubby did my eyedrops out in the lobby before we went
in. People probably thought we were kinky! By the end of the concert, my
Fuchs' eye was totally clouded over from "misty eyes," and my transplanted
eye was hollaring for moisture. But a great time was had by all.
Day 21: Finally picked up my prescription for Pred Forte 1% and started
it at noon. Doctor told me to shake it WELL (30 shakes) and use 4x a day.
It is a milky color, makes my vision a little foggier, and makes my beer
taste funny. But nobody said this was going to be easy. LOL! I already
have a plastic lense in that eye, so this cortizone can't give me a
cataract.
Doctor says I am healed over now and will take me off two of the
eyedrops at the end of the week. I feel great and got my holiday
decorating all done, altho I must say I abandoned those top-of-the-ladder
lights.
Before I had the transplant, I used to blame my horrible depth
perception on having one cataract done and not the other. However, since I
can now see from my new cornea (albiet it's out of focus), my depth
perception has improved.
Day 23: I've been entertaining myself lately (I'm easy to entertain) by
looking at the Christmas tree lights with my Fuchs' eye and then with my
transplanted eye. The Fuchs' eye shows each light as one bright center and
a few dozen needle-like rays radiating out from the center. The
transplanted eye shows not one bright light, but two or three or four
bright lights. I finally figured out that at this stage of my healing
transplant the fuzziness is actually double, triple, or quadruple vision.
I'm back to work full-time and really get mad at myself if I forget to
carry along my eyedrop stash. Never thought I'd look forward to taking an
eyedrop. Oh, I DROVE MYSELF one block today. So what if it was backstreets
and driveways? I made it to a store, bought something, and came back home.
Yipp-e-e-e-e!!!
Day 24: Woke up with my Fuchy eye somewhat cloudy, so plied it with
Muro drops. The transplanted eye was still seeing double and triple
vision, and felt quite like it was dilated, too much light, and "I need
reversal drops!" Paperwork was quite a job, but I was able to wrap some
gifts, clean the bird's cage, make some phone calls.
Day 25: My vision today checked out (uncorrected) at 20/60 minus 2 in
the transplanted eye (Was 20/300 before surgery). The epithelium is
completely healed and the eye appears to be perfectly round. I discontinue
two eyedrops (Atropine and Ocuflox), stay on Acular another 2 days, stay
on Pred Forte approx. 25 days, and next visit will be two weeks from now.
I told Dr. my eye seemed to be dilated all the time, and he told me that
was from the Atropine, and the pupil would get back to normal in about 30
days (long-lasting stuff!)
Day25 outdoor photo shows my "old" Fuchy eye squinting, as
usual.
Evening photo with camera flash catches the glint of the
stitches.
Best photo I could get of the stitches.
This story now continues, following the journey of my continuing
healing and vision improvement.
Here is my Update.
My Corneal Transplant
