9 months later - around half way will the stitches are scheduled to be removed.

Its now about 9 months since my operation.  I haven't updated the blogfor a while.  Partly this is because my eye doctor says I am far from a typical case and originally part of the purpose of this blog was to let people know what to expect.  The other reason that I haven't written for a while is that my eye has not been bothering me very much.

My eye has been largely free of pain the last 6 months or so.  It's also a lot less sensitive to light/wind etc then it was before the operation.  I am not sure how much to read into this as I am still on steroid eye drops (maxidex) which have a powerful inflamitory affect.  The real test will be when I come off maxidex.

My total vision from both eyes is pretty good and I am pretty happy with it.  Thats said my vision in the eye that was operated on is not great.  I can see 6/12 well and can probably get 9/12 just.   The amount of prescription needed by my eye has significantly and steadily decreased over the last 6 months, while my vision has maybe improved slightly.  Most of the decrease in the prescription needed for me eye is due to removing extra stitches that he added to hold my cornea steady.   These are one off stuicthes that he added after the first operation failed and he has not ever used them before.

I think my astigmatism is around 1 diopters and my short sightedness is around 2 or whatever they measure this in.  I'm not confident about that measure of short-sightedness.  At any rate its within what galsses should be able to correct effectively and not so different from my right eye that the difference should cause complications.

My eye doctor is puzzled that my vision is not better.  When looking through a pin whole the eye can see  20/20 or better which suggests the issue is from my cornea.  He said he has done worse lookoing grafts and had patients get better vision from them then I have.  The topography of my eye looks okay.  Last time I saw him he was thinking about getting me to have a wave anaysis done on my eye, which should show where the light is going and why its not reaching my retina in an optimal way. 

There is a real chance that my vision will increase when the final stitches that go all the way around the outside of my cornea are removed.  There is also a chance that this will not help.  Untill I get a wave analysis done I don't think there is anyway to know why my vision is not better now.  I'm due to see my eye doctor in about 2 months and if my vision hasn't imporoved more by then I expect that the wave analysis will be the next thing he wants to do.  Given my total vision from both eye is pretty reasonable I'm not too concerned but I guess I will get it done.

While the vision hasn' t been as good as promised, if the comfort continues when I come off the medication the reduction in pain will make it worth while.  The eye does work wel enough for me to have good depth perception.  It's good to be freed from the hassle of managing a gas permiable contact lens.

2.5 months later

I saw my surgeon again 2.5 months after the latest attempt at a cornea graft.   My eye continues to show much better signs then it did last time at this point and there is no reason to think that everything isn't going to plan.

Dr Maloof said he had never had to redo a graft like this before and he couldn't altogether explain why it hadn't worked last time and now seemed to be working. As well as the ring of sticthes he did say he had addded a few more to help prevent the graft from moving.

Strangely without glasses I actually cannot see much better then last time - this time it appears I am quiet short sighted!  However more importantly the cornea seems pretty stable and when I look through the lens I can see better then I ever could following the last transplant - and the vision could still be improving!  Hopefully in the next 2-4 weeks I will be able to be prescribed glasses which will be pretty much in the usual time frame for this sort of thing.

I don't have to go to Sydney to see Dr Maloof again for three months!

This post is about two weeks late.   However I went and saw the surgeon again.  He told me when he removed the old cornea he found it was soft and not properly formed.  So removing it appears to have been a good choice as it was unlikely to come good.  On the other hand we still don't know what happened, but apparently the cornea may have gone wrong since it was grafted on to me.  Which is a little discouraging as the same thing could happen again.

That said the eye does seem to have been less painful then last time.  It's not all good though I've been back at work two weeks tomorrow, but several days days I've had to work reduced hours or even today not at all which is very annoying - and I think it shows a slower then typical recovery.

1 week on

I had another transplant 1 week ago.  My eye is still very sore and very very sensitive to light.  However it hasn't had the really intense periods of pain as badly as it did last time so I am hoping thats a good sign.

I was surprised by the surgeon saying to me as I was wheeled in that he was going to make the new transplant .5mm bigger then the last one.  It didin't seem much bigger at first but the first one was only 9mm so .5 is a bit.  If my calculations on the surface area of a circle is right then its approximately 11% bigger - which might be enough to be significant.  THe cornea is really more like part of a sphere then a circle which probably makes it slightly larger again.

The idea is that if the donor cornea is stronger having more of it in my eye should make my eye stronger.  Last time he said that 9mm was a big implant however so I guess he was approaching as big as they can be done?  Tey do have to leave a little of my cornea so the surface will grow over the donor cornea.

My eye is too light sensitive to really look at the screen as I type this so hopefully there are not to many typos!

I've taken no photos this time.  It looks very similar to last time.  Possibly it was slightly more red...or I wasn't taking photos last time when it wwas at its most red.

The operation was supposed to be today...but there were no donor corneas available and so it maybe be a few more days before it goes ahead now. 

Interesting;y I found an article on the web about how the EU is later this year starting widespread use of artificial corneas.  Who knows how long that will take to reach Australia - or if it will actually produce a better result or just be a way of getting around a shortage or corneas.

giving it another go

yep in early June I will give the whole mdalk (stromal transplant) thing another go.  Who knows for some random reason it might go better this time...

16 months later and bad news

I'm just back from the doctor and this time the advice I got was very different to last time. Last visit I was told my vision would 'definitely' end up very good - 6/7.5 was mentioned as a minimum.

I found that very encouraging around the end of the year I was beginning to think the operation was a failure and I might have to get it done again or have further treatment such as collagen cross linking.

This time it was Dr Anthony Maloof who said he was really disappointed with the performance of the cornea which is a different shape everytime I see him. He said the options for treatment were:

Collagen cross linking to toughen up the cornea. However while this seems very good for stopping the gradual change in a cornea associated with keratoconus there was no guarantee it would be able to stop the greater variations that my eye was going through. He also said that it could take up to 12 months before I got the full benefit of that and already a lot of time had been spend stuffing around with my eye. I had noticed that too!

The other option would be for him to perform a new partial thickness stromal transplant on the eye. This was the option he recommended. He admitted it may not work better. If the issue was with the donor cornea (which apparently cannot really be tested while it is in my eye) then it would fix the problem. If it was because somehow the donor tissue and my tissue did not join properly there was a good chance it would not happen again. If the issue was with my tissue around the donar cornea changing shape...well lit would probably continue to the same after the operation. I imagine there are other possibilities as well but they are the only ones discussed.

bleh so I'm not very happy about this. I have bunch of questions to ask him. I've started some allergy desensitisation which will probably take several months - should I finish this before the operation. I noticed this year my eye (probably because of allergy) was much worse around january - should the operation by then NOT done in december like the last two? Last time I found wearing a soft contact lens greatly reduced pain - given it turns out inflammation can lead to issues with healing should I preventively wear the contact lens?

I'm going to have to ask my optomitrist if he thinks there is a trend for the changes to my eye decreasing and what he thinks about having the operation again. I'm wondering about getting a second opinion though I am not sure from who given Dr Maloof is supposed to be a leader in this type of operation.

I do remember on my first checkup maybe two weeks after the operation talking to another pateint who was doing much better then me...is that cause operations disagree with me or just this one.

He says he would be happy to do the operation under a local anaesthetic if I thought I would be ok with that. hmmm.

Dr Maloof said I am the first patient of where he thought he had to try to take the stitches out early to stabilise the eye. I am also the first where after this amount of time he has offered to do the procedure again in order to get a stable eye. SO much for a normative blog for others to read! He said that this time he would not charge more then medicare and my health fund would cover.

The next bit will probably bore the causual reader but I'm going to put some readings up....if nothing else it may make it easier for me to refer to them again!

25th Jan 2010. 48@82 41.2@172 +1.75/-5.00@150 vision with this prescription 6/9

After operation to correct curvature:

9th Feb 46.8@72 42.5@162 +125/-5/50@150 6/21

2nd March 46.0@66 43.0@156 +125/-500@135 6/15

6th April 2010 45.7@65 42.8@155 +1.75/-600@135 6/12

as you can see the vision is constantly improving since the trama of the feb operation - however each time the prescription is different which means its all pretty theoretical and I have actually had no prescription lens during this time. They take 2 weeks to order...it would be out of date by the time it arrived. Yesterday (13th April) Dr Maloof took new readings. he didn't tell me what they were only that there were quiet different from the readings on the 6th April and that the corrected vision was actually worse. It will be interesting to see what Andrew Watkins get when he measures me next - which will be as soon as he will see me next.

I've also got hardcopies of lots of pretty topographical maps taken over this period. The Topological maps show the curvature of the cornea. It should be constant. Where it is red it is too steep. This makes the eye stick out more - or be in a "cone" shape which is where keratoconus gets part of its name from. Here are comparative topolgical maps from Feb and April - you don't have to understand them to see that they are quiet different. My right eye taken over the same period shows minor difference - I don't think it has really changed so maybe there is some level of error in these measurements...even so these are quiet different. I just noticed the numbers at the bottom of the topological graphs which show more readings with different astigmatism! I'm not really sure what the diagram on the left means. (anyone care to share?)

(Click on image to view larger)