2/19/10 - Stitch Removal Day

So today was an interesting day.

As I think that I mentioned, I had an appointment with Dr. Rapoza to evaluate me to have the stitches removed from my graft. The reason for this was that Dr. Watanabe was having a lot of trouble fitting me with a lens (soft and hard corneal and even sceral) as a result of the fact that the stitch line was raised on my graft and any of the contacts we tried were rubbing on the stitch line. This was complicated by the fact that soft lenses (the best fitting) tended to cause infiltrates and an infection in my eye and hard lenses were being pressed down by my "tight upper lid" and rubbing on the graft. The worry here was that the neovascuralization (blood vessels growing in to my graft) could eventually cause rejection. The hope was that by removing the stitches, it could make it easier to fit a lens.

I am attaching below, some interesting pictures of my eye that Dr. Watanabe took. I am wearing a sceral lens in these pictures and you can see the following:

Picture of my eye with flouroscein (a liquid that glows under certain lights). The purpose of using the flouroscein is that it glows wherever there is liquid.



You can see here that the flouroscein is glowing under the entire lens, except at the top part of the eye. This is how you can tell that the top part of the lens is pressing on the top part of my eye, i.e. that there is no room for the liquid to move underneath the lens. Dr. Watanabe will often refer to this as a “thin” area as well.



This next photo is even closer and in it you can see that in the area where there is not much flouroscein, there are little glowing spots. Dr. Watanabe refers to these areas as being “stained”, which I believe is a sign that there could be potential scarring from the rubbing of the lens in these areas. You can see that the most “staining” is around the stitch line.



The last photo is a close-up of the top part of my eye, without the flourscein. You can see in this photo that the blood vessels are growing into the graft a bit and also can clearly see the stitch line and the contact lens edge.



Dr. Watanabe forwarded these pictures to Dr. Rapoza to show him what he was talking about – pretty cool that you can even take these types of photos today and also that my two doctors can communicate this easily!

When I went to see Dr. Rapoza he told he a couple of things:

1. He did not think that the vascuralization was that big of a deal. It was not great, but he did not feel that it posed any major threat. As such, he told me that he thought it would be ok, if I wanted, to keep wearing the sceral lens and to take my chances with the rubbing. As he noted, I really do not see out of that part of my eye anyway.

2. It was not a big deal to take out the stitches. He actually said that he used to remove all stitches at the one year mark, but now usually left them in until something broke. Apparently, with Keratoconus patients, there is not much danger of the cornea “unraveling” as the eye is otherwise very healthy. He told me there was always a danger of this happening and that if it did, I would need to have an emergency procedure, but that in his 20 years of practicing, he had never had this happen on someone with my condition.

3. I also asked him about doing a correction over the graft, i.e. laser surgery, etc. He did not think that this was a big deal at all and told me that if I wanted to, once the stitches were removed, that I could wait about a year (for the eye to settle) and then could have the correction done. Unfortunately, it is not something that is paid for by insurance, but other than for the cost, he did not think that there was any downside. It is interesting that Dr. Watanabe thinks that this is really more of a last resort and Dr. Rapoza thinks it is not a big deal.

4. He let me know that if I have the stitches removed, that it would likely make the fit of a contact easier (as Dr. Watanabe suggested) but may result in some other issues, i.e. somewhat of a stigmatism being added to the eye, as the eye was almost perfectly spherical right now as a result of the adjustments he made to the stitches.

I decided that I thought it made sense to have the stitches removed, as I really would like to get to a point where I have a contact lens that fits me correctly. Dr. Rapoza then proceeded to put a couple of numbing drops in my eye and once I waited a few minutes for them to take effect, he held my eye open with his hand and cut the stitches out of my eye with a surgical blade. Needless to say, it is a little unnerving to let someone stick a knife in your eye when you are fully awake, etc. and also seems crazy that Dr. R has the dexterity to do this freehand, but he did it. Apparently, he made a series of small cuts in my eye around the stitch line and then pulled them out. It was a totally painless procedure and took about 2-3 minutes.
My eye is a little scratchy right now, as he predicted and I am taking some anti-biotic drops to prevent infection, etc. He actually told me that I could wear a lens after a couple of days and even that day if I needed to for driving, etc. I am waiting a couple of days to put anything in my eye to be safe and actually have an appointment this Tues. with Dr. W to have a new contact fitted.

A couple of interesting things to note:

1. When Dr. Rapoza was actually cutting out the stitches, he noted that the blood vessels were actually growing into the graft more than he might have thought at first glance and that Dr. W was a “keen observer” to have noticed this – again, kudos to Dr. W.!

2. I am noticing that I do not see as well at close distances without a lens in my eye now that the stitches have been removed and I am betting this means that removing the stitches added some astigmatism to my eye.

In any event, that is the update. Thanks to everyone that is still reading and those that have sent me messages – it is always great to hear from everyone!

18 comments:

  1. Dear Brent
    I had my transplant in Nov 08. And I also had a lot of issues with stitches causing astigmatism, removal of stitches which changed everything again. I enjoyed reading the ups and downs of your journey. And I identify with the joy of seeing, the dismay at how this is so much more complicated than expected, etc.

    I also have a blog http://third-ear-eleventh-finger.blogspot.com

    It's more about the adventure of changing vision and its impact on life. I am new at blogging because my vision before did not allow me to use computers. It's a great new toy! Along with a great new world!
    Hannorah

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  2. Hang in there Brent...Your attitude will make the difference!

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  3. Thanks for writing your story, it has help with some of my concerns...I go into sugery tomorrow!

    Thanks-great attitude throughout...

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  4. Whats up Brent how are you doing , long time no posts?
    I just got back from my doctor after 1 - 1/2 years all stiches were out and was ready for contacts, but no luck now I have catarct in my transplanted eye, have to go into surgery June 1 to remove catact and insert new touric lense to correct stygmatism, here I go again
    Mark

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  5. Thank you for this good topic, I was really needed it, so thank for you again And I know more information about this topic , you can found it in this file

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  6. Thanks for the blog and information. I will soon go through the same surgery. The insight has been helpful

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  7. I just went through a transplant and have put together a entry on my blog describing how it was for me. Hopefully folks will find this useful

    http://www.cvxvx.com/a/Blog/Entries/2010/7/10_Corneal_Transplant.html

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  8. Thanks Brent. This blog helped me greatly. I just had transplant surgery and am recovering. I wish you would update so that I can follow your progress. Thanks JA, Atlanta

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  9. Hi Brent... your blogs have been a great help. im not going in for my transplant surgery until July 2011 however am freaking out about it still. Im 30yrs old and have never had to go in for any surgery and never been in hospital for that matter (which im grateful for). However now having to need this transplant is totally freaking me out. Your blogs have been very useful to read up on and to understand your experience. Really appreciate it.

    How are you going with the results from the transplant now... i really hope that it was even more successful then the dr hoped it to be.

    All the best and thanks once again.

    Regards,

    Paul
    Melbourne, Australia

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  10. great blog, thank you for documenting this. I was googling eye transplant surgery because I work at an eye bank recovering donor corneas when I came across it... my part is normally dealing with the death aspect of things, but it was very nice to se the re-birth aspect of the process. you havent posted in quite some time, I hope that everything is still ok and progressing well

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  11. Thanks for writing your story.it has helped me...

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  12. Hi Brent - Thanks for your account of the process of your CT. Your son is ADORABLE! Currently I'm deciding to do INTACS/Crosslinking or a CT as two specialists have recommended each. How did your eye story continue? Did you get fit with gas perms or did you have Lasik? Will we ever know? :)

    Vali

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  13. Thanks for giving me a place to go when frustrated. I am 6 months post cornea transplant OS and getting depressed about the ptosis and continued vision issues. You inspire me to hang in there and be positive.

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  14. Hi, thank you for blogging about your experience. I recently went to have my stitches removed since my graft was approaching a year... And the worst possible thing happened. The graft came out...nearly 70% detachment termed "dehiscence". I was totally gutted. I was rushed into theatre for major surgery. I'm currently five days in post op. My doctor mentioned I could have had weak columnar vascualr bonds that came apart but that simply equates to the stitches being taken out too early.

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  15. Firstly, thanks for blogging your journey. I came searching because I'm having issues post stitch removal. I've had two corneal transplants in each eye. One in 2007, the other in 2013. My eye is so sensitive to light now. I almost wished the stitches hadn't begun unraveling.

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  16. Firstly, thanks for blogging your journey. I came searching because I'm having issues post stitch removal. I've had two corneal transplants in each eye. One in 2007, the other in 2013. My eye is so sensitive to light now. I almost wished the stitches hadn't begun unraveling.

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  17. This is really great information found here, I really like your blog. Thanks very much for the share. Keep posting.
    Affordable Stem Cell Therapy in Chicago

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  18. Thanks for writing the blog! Just had a cornea transplant a week ago in Romania. Useful info. Maybe consider writing a follow-up post in one year or so? Cheers!!!!!!!

    ReplyDelete

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