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The Operation

August 23, 2011

So the big day finally arrived yesterday, and it actually went really well. After waking up at Ridiculous O Clock my mum drove me to Sunderland Eye Infirmary and we arrived at 7:30am. I was introduced to the nurse who would be looking after me for the day and she showed me to my bed. My mum left not long after (the ten year old boy in me wanting to shout DON’T LEAVE! as she did so), and the nurse signed me in- confirming that I knew why I was there and asking if i had any allergies etc. My operation wasn’t due until 9:30am, so I had a bit of a nervous two hour wait. The room I was in had four beds, but the other three were empty, so I took the opportunity to just sit and try to collect my thoughts a bit. The ward was really quiet at that point and I appreciated the sense of calm around me, while inside I was growing more and more nervous.

After a while my consultant and surgeon Doctor Morgan arrived and had a quick examination of my eye. He also explained what would happen in the operation- that he was going to aim to make it a partial thickness (DALK) graft, but that sometimes due to the thin lower layers being pierced it was necessary to convert it to a full thickness graft. He said that if that happened it wasn’t the end of the world- full thickness grafts work perfectly well and have a good success rate, and partial graft’s are basically just an improvement of what is already a successful procedure. Still, I was really hoping that it would be a partial thickness graft for the reasons explained in the last post- not only is the recovery time quicker and it massively reduces the risk of rejection, but the eye is less vulnerable to injury (an eye that has had a cornea transplant is always structurally weaker than one that hasn’t, and a heavy blow such as a punch to the face could cause blindness).

I was quite confident that Mr Morgan could achieve a partial graft however. He has an excellent reputation for doing successful cornea transplants and is considered a bit of an expert in the field. The thing with something like a cornea transplant is that because the process involved is quite technical, the more experience a person has had at doing it, the more successful the outcome is likely to be. This is especially true of DALK transplant’s, which require the layers of the cornea to be removed individually without piercing those two crucial bottom layers. Im not sure how many operations Mr Morgan has performed, but I know that he’s been doing them for nearly 30 years and has an excellent success rate. It was knowing this that contributed to my decision to have transplant in the first place.

So at 9:30am the nurse came to lead me to theatre. By this point I had some very sexy DVT stockings, a giant green arrow above my right eye, and some giant dad slippers. It was a great look. When we arrived outside the theatre room I got onto the bed and the nurse attached some heart rate pads to my chest. My heart was beating like crazy, and the sound of it beeping so fast didn’t exactly help to calm me down!. Then the anaesthetist attached the anaesthetic tube to a vein in my hand and started to apply the anaesthetic. I should say that all the staff were lovely- they had a calm, friendly manner to them and were making general small talk with me the whole time to take my mind off what was going on. It took a while for the anaesthetic to work- the man kept asking if I felt any different and I was like ‘erm….no’. The he’d ask a minute later and I’d be like ‘errrrrrm, no’. They wheeled me into surgery anyway, and i think I was briefly aware of Mr Morgan saying hello and some of the nurses walking about.

And then….nothing. I had thought that the anaesthetic would work gradually- you’d start to feel sleepy and then just drift off, but it really is instantaneous. One minute you’re awake, the next minute you’re gone. I do seem to remember dreaming while I was asleep, but i’ve no idea what about. My next memory is of vaulting back into consciousness as quickly as I’d left it. Mr Morgan told me they’d just finished the operation and that it had gone really well- they’d managed to make it a partial graft and there had been no complications. Even though I was still pretty groggy that one bit of info was enough to instantly put my mind at rest. I was wheeled back into the ward and climbed into my bed, and then spent the next hour or so slowly coming round from the anaesthetic. This was probably my least favourite part of the whole day- I had a sort of ‘car sickness’ feeling of nausea, and even though mentally I felt quite alert, my body was still in sleep mode. My eye didn’t actually feel too painful- a bit gritty, but nothing unbearable.

By this time it was about 2pm, and I couldn’t believe how the time had seemed to go. I thought the operation would only take an hour or so, but it seemed to have taken about 3. My parents came to visit just after 2pm and spent about an hour there. I felt quite alert by this point, but then the tiredness hit me again and they left so i could sleep. I spent the rest of the afternoon listening to music on my ipod (thank god for my ipod), and also managed to eat something. By about 5pm I had some dinner (Cornish pasty and mashed potato for those hospital loving foodies out there), and then Mr Morgan came round not long after to look at the eye. He said he was really pleased with how it had turned out- the problem with doing a partial graft is that it’s a bit of an inexact science. You don’t want to go too deep into the cornea in case you pierce the lower layers, but at the same time you need to go deep enough so that you can achieve clear, crisp vision. He said that he’d managed to achieve just that- the connection between the donor cornea and the layers of my own was quite clean cut and therefore the vision should be really good as a result.

He said that I shouldn’t worry if i didn’t notice a massive improvement in vision straight away- the cornea is still quite swollen after the operation and takes a while to settle down. Even then, the presence of the stitches will still cause some distortion in the shape, and it’s only after the stitches have been removed (probably about 6-8 months in my case), that you get a proper idea of how your vision will be. Nevertheless, I could notice an immediate difference in my vision. I had a menu in front of me and I could actually read the larger letters- that would have been impossible before surgery. I could also make out people’s faces- their eyes, mouths, nose which before the graft would have just been a flesh coloured blur.

Even today the vision has improved more. I can read the page of a book with my right eye from about 20cm away, which again would have been unthinkable previously. It’s not really very clear or crisp at the moment- it’s almost like looking through a window that someone has wiped a fine layer of grease over. As the cornea begins to become less inflamed and settles down a bit the vision should continue to improve, although like most corneal graft patients I’ll still probably need to wear contact lenses to give me really good vision. The difference now is that contact lenses will actually be able to fit to the shape of my cornea and be able to improve my vision, whereas before they had no chance.

After giving me the once over I was told i could go home and got back about 7pm. I’d been in hospital just under 12 hours. I went to bed pretty early and wore an eye guard to prevent me from rubbing my eye or sleeping on it during the night. I also have to use steroid drops and antibacterial drops four times a day- the steroid drops reduce inflammation and lower the risk of rejection, while the antibacterial drops prevent infection- something the cornea is quite susceptible to because it doesn’t have its own blood supply.

So that’s the worst part over. I couldn’t really have asked it to go any better. I probably wouldn’t want to repeat the experience, but it’s definitely not as bad as i thought it would be, and I’m just glad that it’s over now and I know what I’m dealing with. The next stage will be to hopefully avoid infection and rejection, and try to get as good vision as possible. Watch this space!

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