I have been hoping to make the transition to “regular” contacts and so have been testing a series provided to me by my fitter.  Two of the types of lenses were “too tight” meaning that they did not move around the eye enough and were difficult to get out.

It seems that during one of the tests, where the lens was sticking in one place through the day, I caused an microscopic abrasion on my cornea.  I had started feeling a persistent burning/lash sensation on my graft and, being a hyper-vigilant paranoid patient, went in to see Dr. Koffler.  He applied florescence and at first didn’t see anything. But after a few moments he found a minor abrasion in the middle of the grafted cornea and concluded this was the source of my discomfort. The graft looked fine, by the way.

I took a break from the lenses, applied Muro 128 and have settled back into using the “custom” 3-month lenses I was originally using, but with an updated prescription.

Everything is fine now as we move into the holidays.

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.

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, as usual, this is going to take some trial and error!

I have tried three different RGPs (Essilor Perimeter Lens) and cannot tolerate any of them – the mini-scleral was pushing a “grove” into my sclera – apparently my eye was swelling around it?

I can wear them 7-8 hours, but my eye is very sore afterward.    I am now going to be trying a custom-profiled soft lens.  The manufacturer apparently uses my topography to construct them.  I was hoping I could use a soft lens, so we’ll soon know.

Koffler Vision Group is doing a great job.

photo:  Lee J Haywood

Well, I just returned from anther follow up with Dr. Holland post-corneal transplant.  The graft and optic nerve look good, but my eye pressure is still too high – a condition known as “steroid-induced intraocular pressure.”  I’m among a small number (8%) of people who seem to have steady, ongoing eye pressure rises with use of steroids.

We’ve adjusted the type of steroids I’m using, and I’ll be taking a drop to reduce eye pressure as well (the drop is normally used for Glaucoma patients.)   I was also relieved to learn that there were no other reasons my eye pressure was rising (such as tissue or structural complications from surgery.)   Apparently that can happen with full-thickness graft, though rare.  I will be happy when the pressure is moderated – as I don’t like the sound of Glaucoma one bit!   What I think is going on is that I will be using a tiny amount of steroids – far less than most people.   This means I must be alert for any irritation symptoms.

Vision was stable, not that much better.  They claimed astigmatism was down, but I’m not seeing it.  I worked hard to see eye chart numbers.   I wish I’d brought my glasses so they could have evaluated those.  I think it will show I can see pretty damn good through them (despite the old prescription.)

But in terms of graft recovery, things looked good enough to remove a couple more sutures.   This time, the removals had a bit more of a pinch and I was slightly sore afterwards.   Tylenol and back to work.  Next time I might ask them to delay the numbing drops until right before the process itself.   There is this unpredictable delay between numbing drops and when Dr. Holland actually does the removal.   Last time, it didn’t hurt at all.    This is similar to how it went during surgery – my pain meds started wearing off before the procedure was done.  Ouch!

One Niggle… I’m consistently impressed by the Cincinnati Eye Institute Staff, but sure wish they’d dump the blaring TV’s in the waiting room.   It’s not just them, it’s everywhere.  Doesn’t anyone else like to pull out a book to read anymore?

It’s now been 8 days since the surgery.

I worked half a day and went, with Heather, to Edgewood to see Dr. Holland for my “1 week” follow up appointment.  The Cincinnati Eye Institute office was very busy.  We waited 2 hours to see the doctor – so I will never go there in the afternoon again and never on a Friday!  Lesson learned.  The rest of my appointments will be early morning and early in the week.

After we finally got in, the technician checked my vision (strangely, the test was conducted with the band-aid contact lens inserted and affecting my vision.)  I did not get the exact measurements, but I had improved three steps beyond last time on the pinhole.

After Dr. Holland came in, he checked the epithelium (see illustration, top section) to see that it had healed over properly so he removed the bandaid contact lens after numbing my eye.  He used tweezers to remove it, and it did not hurt at all.  As soon as it was out, however, I could feel the dryness start.   Unexpected.

Transitions are always tough.  It was not really pain I felt, but a tickle-itch sort of feeling with a mild burn.   Dr. Holland said that the bandaid lens was holding moisture in before, and I would need to supplement that from here on – these lenses have pros and cons.  But cell growth was great.

Dr. Holland looked me over well with slit lamps with and without florescent die, checked eye pressure and gave me a clean bill of health.   The cornea is clearing, the sutures looked fine, and I was good to go.  I am now to stop using the antibiotic but continue with the steroid and Restasis (tear medicine.)   Now, he said I should expect fluctuations in vision – and that we’re in the long slog of a slowly-healing cornea.

I will be going back in a month, and he may do a topography for the first suture removal, but the decision to remove them will be made on the fly based on the topographies.  I knew this.   He also said that Heather did not need to come with me for those appointments.  I’m glad because it’s a lot of trouble for her to come and wait for me.

I’m to continue wearing my shield at night, and he said sunglasses during the day.   This “wound” is still fragile and I need to take care of it.

We had Buffalo Wild Wings and headed home.  I got very dry on the ride and wished I had brought lubricant.  Once home, I added Systane and it helped a lot.   As I write this, the irritation seems to be fading after a Tylenol

The journey continues…

Postscript: 3/19/11.    Eye really feels raw today.  Hoping this is temporary.   Last night I used a gel-type lubricant before bed and that worked really well.   Steroid drops definitely have a burn now when they go in.   These are some things to expect I guess.

I continue to recover from my DALK corneal transplant/graft procedure on March 9th, and thought I’d bring my (growing) audience up to date on some highlights.  My wife has been a trooper in helping me with things over the last few days, including a bit of grumpiness and anxiety.

Positives:

• Eyelid swelling reduced.
• Eye redness reduced.
• Milky-white vision is gone.
• Pain levels reduced – Tylenol helps with a mild burn in the morning.  I am surprised how quickly pain has dropped.
• The overnight discomfort is near zero.  This is a huge improvement for me. In the past, my gigantic cone would get dry and raw overnight.  I used to have to lubricate every hour or so and the pain would wake me many times per night.  For the last two nights, I’ve slept like a baby without any drugs.
• No post-7:00 pm pain that I had with scleral lenses.
• Foreign object sensation with sutures roughly the same as a RGP lens.

Annoyances/Negatives:

• ITCH!!! The areas around my eyelid and eye socket where the injections were given (I was asleep) became very itchy for a day or so.

  

  If this happens to you don’t forget you cannot rub your eye. Put your shield on and occupy your mind.   It took Benadryl and it helped a bit.

• An annoyance is this “bandage contact lens” I was given.  It’s purpose is to encourage healing of the epithelium and improve comfort while the nerve endings are exposed.  It’s the size of a quarter-dollar and does not fit well and makes my vision “wavy” – like looking through a wine glass.  If I turn my head slightly, I see bits and pieces of what’s to come.  This morning, from across the room, I caught a glimpse between the contact lens waviness of my iPhone clock – and it was as if I had 20/20 vision for a moment.   Last night, I glanced at the stars and could see that shortly, I’ll be able to enjoy them again.  This should come out at my next Dr. visit.
• Light sensitivity.  My doctors said that this was quite normal.  We’ve had beautiful sunny weather in Kentucky and I’ve needed to remain in the shadows.  A dark-black patch (available at your local pharmacy) has been tremendously helpful.  I recommend those having surgery buy one.   Dark sunglasses not enough for me.
• Steroid and antibiotic drops have a mild, temporary burn – but these are critical to recovery.
• I caught myself drifting off to sleep once without my shield.   Must not!

My activities have been slowly increasing – I went out to breakfast with my wife and eldest daughter yesterday.  Enjoyed it, but had to wear my dark-black patch to avoid the brightness.   I took my bike for a short spin in the neighborhood on the widest lanes.  Dozens of neighbors out enjoying the Spring day.  I did some minor repairs around the house and tried to help with regular household chores (avoiding those requiring lifting or extensive bending.)

I will check in again in a few days.  So pleased to get the encouraging messages, thanks to all.