Travels with FatCatAir

Friday April 11, 2008

Less joy

Back in November I wrote about my experience with retinal tears. I was hoping that was pretty much the end of the story. Unfortunately it wasn't since that entry I've had more issues. At first it wasn't too bad. Originally I had three tears, one big one and two little ones. In December the big tear and the nearby small tear joined forces to make one large tear. This wasn't too bad since I noticed it quickly and it was lasered and things were fine.

Things seemed to proceed ok until early February with only biweekly visits to the doctor for checks. It looked like I was pretty much out of the woods. On Feb. 2 I noticed a little bit of flashing in my eye that lasted for a couple of minutes. It was barely visible, had the lighting situation been any different I never would have noticed it. I debated calling the doctor about it but since it was so shrt lived I decide I'd just try and pay close attention and see if there was any change in the floater situation. In hindsight that was a bad idea since I had so many floaters (tens if not hundred of thousands) that detecting any change was probably unlikely.

The next Saturday (the 9th) when I went to bed there was a bright light in the upper right of my eye. Not good. Why does this stuff always happen on the weekend? On Monday I made an appt. with the doctor to get it checked out on Tues. As far as I could tell there was nothing different in my vision, in fact I passed my 3rd class FAA medical that day.

Tuesday came and with the testing the technician did before I even saw the doctor, it was clear I had lost a bunch of peripheral vision. The doctor then confirmed the worst. I had a new tear in a completely different place and the retina had detached. I would need surgery Wed. morning. The good new, if there was any, was that they'd do a vitrectomy so all my floaters would be gone and I could expect my normal vision. The bad news was I'd get a gas bubble inserted in the eye and I'd have to maintain a certain head position for 10 days. Also I could expect to have cataract surgery in 6 months to a year.

I went to the hospital early Wed. and they surgery was performed. Well not really. Shortly after the surgery had started I suffered a suprachoroidal hemorrhage in my eye. This is the bane of eye surgery. It is pretty rare something like .02-.05% of any eye surgery where the eyeball is opened up. Since cataract surgery is the most common surgery of this type it is seen there most frequently if you can call .02% frequent. This basically stopped the operation since this lifts the retina up and if that wasn't bad enough the surgeon can't see for the blood. This complication is pretty devastating as far as final visual outcome. Any chance for 20/20 was now gone. The next day when the patch came off the eye I found I was now blind in that eye. Well I could detect light. I called it my one pixel eye.

Now we'd have to wait for me to recover from the hemorrhage before we could operate again. We'd also have to hope that it wouldn't just happen again. If the probabilities were independent I'd have nothing to worry about. Unfortunately they aren't though it is pretty common for subsequent surgery to go fine.

 Two weeks later it looked as if I was at the point where a 2nd surgery could be done. It was hard to tell for sure because the retina wasn't really all that visible. They had to use ultrasound to make the decision. The second surgery lasted 3 hours and went well. At least in the sense I didn't hemorrhage. They were able to do the virectomy, remove my lens, reattach the retina and fill the eye with silicone oil. The next day when the patch came off I could see, after a fashion again. Unfortunately they weren't able to get all the blood ought from under the retina so there was concern that when the blood there dissipated that the oil wouldn't make a good seal. The hope was that by the time that happened the retina would be fairly well attached and not detach again.

No such luck. The blood dissipated and two weeks later my retina detached again, all the way to the macula. Now the plan was to wait until all the blood was completely gone and try yet again. Two more weeks of waiting. The 3rd surgery was March 26. I was hoping that the third time would be the charm. I was brave enough this time that we did the surgery under local anethesia. I actually have a memory of seeing the instrument working inside my eye. This surgery seemed to go well. The blood was all gone. The retina went down nice an flat and there was a good fill with the silicone oil. The doctor and I were very hopeful.

I was really sweating out the first two weeks since after the second surgery I wasn't able to make it two weeks before the retina detached again. Although it wasn't like I'd be out of the woods at two weeks it would be some kind of milestone. After this operation I paid close attention to the vision in that eye and it was clearly getting better every day. It was great because of distortions but it clearly improved daily. I was also aware that it was better than it was at similar days after the 2nd operation. I was very hopeful.

Last Tuesday was my scheduled follow-up visit for 2 weeks post-op. I definitely like going on the scheduled visits because the unplanned ones are always bad. The bad news was that Monday evening I became concerned that I could detect signs of detachment again. They were very subtle so I wasn't sure. Tuesday came and I go to the doctor. I could read the line (well read is too strong a term) under the big E. Unfortunately the doctor confirmed that I had a new very small detachment. Damn!

Now I had to decide what to do. Try again or just give up on the eye. My doctor suggested that I might want to have another doctor try the surgery. I had been to the Duke Eye Clinic after the hemorrhage and my doctor who interned at Duke suggested that the doctor I consulted with there would be a good choice. My initial instinct was to give up and just let the eye fail and get on with my life. I was just tired of the surgeries and the restrictions they imposed and it just wasn't clear that even if things were successful that I'd get reasonable vision out of that eye.

So one of the things I'd been wondering about was how much of the distortion I was seeing was caused by the silicone oil and how much was damage to the retina. I had noticed four different distortions. One if you looked at the lines painted on the road. The lines in my right (bad) eye were at about a 20 degree angle to the lines in my left eye. Also thing were very slightly different sizes. Also I noticed that if I looked at a picture frame it was not rectangular but was a parallelogram. Finally there was the fact that there were no straight lines. Any horizontal or vertical lines had two little bums in them.

I suspected that the angle and tilted vision thing was caused by the oil in the eye (probably by an index of refraction difference compared to the vitreous) and my doctor agreed. I was surprised at how little I could find on the internet about this though. It's one of the reasons I'm writing this so the next person my at least find this entry. I did finally manage to find a document that was for a different surgery but still used the same oil that mentioned the angle/tilt distortion. So now I could at least believe that after the oil is removed (6 month to a year after successful surgery) that this distortion would go away. From what I could find it seemed likely that the little bends in straight line are caused by the retina not being quite flat. In theory the oil will tend to smotth these out over a few months. I sure hope so.

So now I've decided to try operation number four and this time to do it at Duke. Since "third time is the charm" didn't work out, I'm counting on "fourth time is the fix". We'll see. :-)