I’m having more dry eyes than before now, so am keeping Systane with me at night, adding drops anytime I’m even slightly awake.

When I do have a “dry eye pinch” (usually caused by opening my eyes suddenly while they are dry) it can cause me to have blurred vision for 24 hours, which doesn’t make it easy to work!)  So I’m doing all I can to avoid this happening.

I’m reconsidering Restasis again, despite the cost…but Dr. Koffler told me about a dry eye “serum” which can be created from my own blood (really!) and turned into eye drops that lubricate as well as heal.  That sounds amazing, and I assumed it would be horribly expensive but he said it was about the same per-dose use as Systane.

I am giving it serious thought, but for now, my dry eye is fully under control and my vision is sharp.

Also:  No significant changes to my prescription, so have no plans right now to change glasses.

Update: I also have some thoughts that this blurring is also caused by medicine, including Benadryl and Zyrtec.  Apparently these impact one of the muscles that is used for close vision focus.

After a clean bill of health from Koffler Vision Group, the diagnosis was dry eye, so I’m ramping up the Restasis ($) and systane.   I had them check my eye pressure, look at the optic nerve, and check the corneal thickness.  The Dr. said my graft looked “gorgeous” and I had no worries there.  My vision checked out at 20/30 and I was out of there!

All came out great.  I know I’m hypervigilant and possibly a bit psychosomatic, but I really value my vision.

My graft is quiet and my eye pressure and corneal thickness are fine.  Dr. Holland reminded me of what to look for – light sensitivity and redness in the left eye only.  I watch it like a hawk.  He said I’m out of the major rejection period, but to always assume rejection when symptoms emerge “until proven otherwise.”

I’m to keep using Restasis 2x per day (indefinitely) … I learn a bit more each visit about how beneficial these drops are to preventing rejection.  Expensive but worth it, and better than steroids for someone like me who responds to them with increased eye pressure.

No more appointments for 1 year unless needed.

The broken suture was no fun, and I have to travel some on business – was worried that would happen in an airport or in front of 200 people.

So today, he cut the last four from my graft.  There are now no mechanical connections between my body and the donor’s cornea.  That made me anxious for some reason, but I was reassured that it would be fine (unless I got boxed in the eye!)   We tested my eye pressure, vision and did a topography.  All good.

Time to remove the sutures…

The normal drops for numbing and within 5 minutes he’d removed them.   We talked again about PRK surgery in 5-6 months and I was on my way.

Ow.

After the numbing drops began to wear off, I took a couple of Tylenol.  But it was pretty painful.  The longer sutures are in, the more they seem to hurt after removal and numbing meds wear off.

Ow. Ow. 

By 4-5 pm I was very uncomfortable, and took 1/2 of a stronger pain pill which helped.  Also added some Systane to my eye – because the pain is likely caused by the inner eyelid rubbing on the freshly cut areas of my eye.

My plan is to medicate myself liberally tonight and hope that things are better in the morning.

Our PRK discussion was about trying to get my left eye free from the need for any contacts at all.  I asked about risks and Dr. Holland made the point that the risks for PRK are about the same as long term contact lens use (infections.)  So I am strongly considering it, despite the out-of-pocket costs and another procedure on the eye.  We will discuss in 4 months.

Follow up:  2 days later.

Pain is gone and only a residual dryness remains.  I have been doing my antibiotics.  Went metal detecting Saturday and Mountain Biking Sunday and it was great.  Safety glasses for sure!

Had a bit of an issue last night.  After taking out my contacts, my grafted eye started to sting like a really, really bad eyelash.  I immediately knew what it was – a suture had broken during the day.  I still have four sutures that Dr. Holland had wanted me to leave in for as long as possible.  No panic.  But time to put the plan into action.

The sensation was a sting, worse than an eyelash in my eye.  I looked at my eye carefully in mirror under magnification, and I could see a tiny little spot where the suture had been moving around.  In the center, a tiny, tiny little suture sticking straight out.   I noticed it after contact removal because my contact was acting like a bandage lens preventing the little suture from moving around.

At a previous appointment, I had asked Dr. Holland what to do if this happened, so when it did, I tried not to freak out.  I went ahead and put a drop of Vigamox (antibiotic) in before heading to bed to keep bacteria from growing in the micro-wound – with a plan to call in the morning.

Dr. Holland had previously told me that I didn’t need to drive to his office (90 minutes away) if this happened, but to just go to a local surgeon in Lexington.  I contacted Dr. Koffler’s office near my house and they had me in at 8:45, and the problem suture was out (or part of it) by 10 AM.

But the suture didn’t come out cleanly.  As you may remember from a previous post, the cornea is getting stronger all the time, and the sutures are getting pretty cemented in and losing some of their strength.  When the Dr. grabbed the eroded suture to pull it out, it broke into two pieces at the knot, and only the protruding section came out on his tweezers.  He tried to get the other one, but it was “scarred in” and he thought it better to leave it there rather than cause too many scratches on the graft.  He guessed that it would never be an issue.  Fine by me.  It would not be painful because it was under the skin.  I’ll let Dr. Holland look at it when I’m up there next.

I’m on a 4×4 regimen of Vigamox and have to leave my contact off for 48 hours, but I think all is okay.  Once this is settled, I’ll call Dr. Holland and see if he’d like to take out the rest of the sutures (so they don’t give me trouble during a business trip or otherwise inconvenient time.)

So… inconvenient, but no panic.  Rather straightforward resolution.  On with the day.

Here is an illustration of what happened to the best of my ability… the (A) is the protruding suture that was getting moved around and where things hurt.  The black dots are the knots.

He says that we will leave the sutures in until they cause issues, and eventually one will break.  I’ll just go to a local surgeon to have them removed.  Here’s a boring image of my topography.

Everything feels fine – still using Restasis for dryness and as an anti-inflammatory –  It’s almost allergy season, so I will start my daily Zyrtec soon.

Dr. Holland re-iterated that my graft is looking good and should last the rest of my life.

My eye pressure was 18, totally normal.  The graft was crystal clear.  No problems.  I complained about my dry eye at night and he suggested I change to a gel based lubricant and gave me some samples.  I’ve used them before and not liked their goopiness.

The topology (right) showed that it was time to remove two more sutures, so I was numbed up and Dr. Holland started the process.  It seemed to take longer than usual to cut and pull them out.  I was stone-still during this process.  Anyway, after the numbing drops wore off, it was pretty sore – yowch!  The sutures seemed to be a bit stubborn.  I think that the longer they’re in, the more they integrate into the tissue of your eye.  I took some Tylenol and started my weekend a bit early

Anyway, the usual Vigamox antibiotic dose for 3 days and go back in 4 months.

Now I will make an appointment to get fit for contacts to match my new Rx (suture removal changed my astigmatism levels.)

postscript:  Eye was completely normal the next day.  No discomfort at all. And I think my vision has improved a bit, especially with my glasses.

Well, it’s been a good week for my DALK recovery.  I went back to Dr. Holland for my graft checkup and he said it was perfect.  I also corrected to 20/20 on their refraction gear.  I had already ordered a new, special soft contact (see last post) and was not able to take it with me to Dr. Holland.  He wasn’t bothered by that and said that if the soft lens worked for me, it would be fine for my eye.

The downside to the soft lens (at least the first one I tried) is it corrected me only slightly better than 20/30.  This means there is room for improvement.  But the comfort is … amazing!   The fitter (Tamra at Dr. Koffler’s office here in Lexington) seems to think that I should wear it for a week and then we may want to correct the power to hit near 20/20.

Other questions answered:

• Sutures:  We’ll take them out if they degrade.  Otherwise, he said, leave them in for now.
• Graft Fragility:  I had lots of anxiety about the graft’s fragility, but Dr. Holland told me to quit worrying.  It would take a severe trauma to disturb the graft now that it’s healed up.
• Rejection Period:  I’m exiting the prime rejection period for DALK.
• Glasses:  Dr. Holland said to go ahead and make the lenses for glasses.
• PRK/Lasik is still an option if we cannot make contacts work.   Insurance won’t pay for that in KY (or OH.)
• If we run into suture issues (e.g. one breaks) we will remove them all at once.
• He said it was right to stop wearing the RGPs if they were hurting.  He said I should be pain free and use whatever gives that to me.

Exciting!