1/28/10 - Lots to report

It has been a while since I last wrote on this blog and a lot has happened!
I believe that the last time that I wrote, I had been dealing with NV issues with blood vessels growing into my eye. This crisis was averted after a visit to Dr. Rapoza, who seemed to think that it was not a large problem and just should continue to be monitored.

After this visit, I proceded to wear a soft Acuvue Oaysis Silicone Hydrogel lens in my eye for a couple of months. I got really decent comfort and not bad vision out of the soft lens, so I really thought that I was going to be fine, boy was I wrong!
I ended up getting busy with life (work, family, etc.) and did not see Dr. Watanabe for a couple of months. We were supposed to be continuing to explore fitting an RGP lens to my eye, as it would be better from an oxygen permeability perspective, etc. When I did end up seeing him, it turned out that as a result of the soft lens that I was wearing in my eye, I had developed a pretty severe case of infiltrative keratitis with KPs, which basically means that white blood cells had infiltrated my cornea as a result of an infection in the eye (most likely under the contact lens). This apparently can happen with soft lenses. Apparently, they were coming in both from the outside of the eye and the interior of the eye, which is bad! The biggest reason that this is bad is that it can cause a rejection of the corneal graft. I ended up having to put a couple of drops in my eye 4 times a day for at least a month (Pred Forte and Tobramycin) – I believe that the Pred Forte is a steroid for anti-rejection and the Tobramycin is an anti-biotic for anti-infection. I also needed to remove my contact lens from that eye for the entire time, which of course is difficult, since I then see only out of one eye and badly!

On a positive note, the infection cleared up, and after about a month I was able to put a lens back in the eye. Since I can’t seem to find an RGP that fits, Dr. Watanabe has been experimenting with scleral gas permeable lenses, which are basically huge lenses that vault over the cornea and sit on the white part of the eye. This fitting process has been quite difficult, as I have a ton of eye issues, which include:

1. My corneal graft is raised at the stitch line, so most lenses, even really big ones rub in the stitching line.
2. My eyelid is really tight so any lens that sits on my eye get’s pushed down by my eyelid, creating a situation where it does not sit centrally
3. I have the neovascuralization, so any lens needs to be really oxygen permeable
4. I have this propensity to infection so any lens needs to have fluid exchange under the eye (note: most soft lenses that are oxygen permeable, allow less fluid interchange)
5. I am really nearsighted on top of everything - +8.0!

The reality is that all of these problems make it really difficult to fit any type of lens to the eye. So in the fitting process for the scleral lens, I ended up wearing soft lenses to try to see something that worked, including going to a different cleaning solution (clear care) and also trying one a day lenses. I even ended up wearing 2 week lenses every day at one point, which is pretty expensive, but worth it to keep my eye clear of infection. The unfortunate reality is that about another month later, yesterday, I went back to see Dr. Watanabe and found out that I have more white blood cells in my eye. Unfortunately, this means more drops and also a period of not being able to see well again out of that eye.

Dr. Watanabe and I discussed my options and it looks like the best one, after consulting with Dr. Rapoza, is to remove the stitches from my graft early, which will hopefully help with the fit of an RGP lens. I now need to make an appointment for this and also continue to try different lenses and stay on the drops in the interim. Hopefully, this works, because I seem to be running out of options. It has now been over a year since the surgery and I still don’t see well consistently out of the eye, which is frustrating.

I am continuing to stay positive and of course realize that there are things that can be done, including having lasik or something similar over the graft (which of course is dangerous)….

I am going to discuss all of my options with Dr. Rapoza and am also hopeful that the removal of the stitches makes the contact lens easier to fit. As always, I am grateful that I have great medical care to help me through the issues.
Hopefully, I will write more soon with good news!